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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 02/13/2024
Date Signed: 02/13/2024 04:00:27 PM


Document Has Been Signed on 02/13/2024 04:00 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:DARLENE MARKHAMFACILITY TYPE:
740
ADDRESS:475 MARSH STTELEPHONE:
(805) 541-4222
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:100CENSUS: 53DATE:
02/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Darlene MarkhamTIME COMPLETED:
04:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) De Leon conducted 1-year Annual Visit to the facility above. LPA met with Darlene Markham and explained the purpose of the visit.

LPA requested a Resident Roster, Staff Roster, Copy of Facility liability insurance, Copy of the Facility Emergency and Disaster Plan, and a copy of Facility Emergency Quarterly Drills.

LPA took a tour of the facility with Administrator and Maintenance Director. The following apartments were inspected: 101, 104, 105, 151, 152, 153, 156, 158, 160, 207, 212, 220, 223, 251, 255, 258, 259, 262, 263, 350, 352, 353, 354, 357, 359, cottage 118. Also inspected common area laundry rooms, common area restrooms, gym and stairwells.

LPA will need further time to complete the annual visit and will return at a later date.

Exit interview conducted and copy of report printed for Administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De LeonTELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
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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