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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 02/18/2022
Date Signed: 02/18/2022 01:30:52 PM


Document Has Been Signed on 02/18/2022 01:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:AVILA SENIOR LIVING AT DOWNTOWN SLOFACILITY NUMBER:
405850034
ADMINISTRATOR:CASSONDRA BRADFORDFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 541-4222
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 60DATE:
02/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Emily Villegas, Executive DirectorTIME COMPLETED:
01:35 PM
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At 10:40 am, on 2/18/2022, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced annual infection control inspection of the facility above. LPA met with Emily Villegas, Executive Director, and explained the reason for the visit. LPA and Executive Director toured the facility.

LPA’s initial tour of the facility resulted in the following observations: LPA was screened upon entry to the facility by staff, offered hand sanitizer, and required to answer COVID-related questions. Hand sanitizing stations are available at several common areas throughout the facility. All staff were wearing face coverings as were residents seen in common areas. Bathrooms in common areas do not have handwashing reminder signage. Executive Director will post handwashing signs in all common area bathrooms and send photos to LPA. Fire extinguishers are in compliance and were tested on 1/24/22. The facility has a double gate near the garden that needs repair and an automatic closing mechanism. Executive Director will ensure gate is repaired and send a video of gate automatically closing to LPA.

At 12:20 pm, LPA conducted the Infection Control mitigation module with the Executive Director. No deficiencies were noted.

Exit interview conducted and report emailed to the Executive Director.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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