405850034-2-8-2024-29-AS-KBUY-D2W47Y-20240228175154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 02/08/2024
Date Signed: 02/08/2024 05:33:22 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/06/2023 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20230706125300

FACILITY NAME:	AVILA SENIOR LIVING AT DOWNTOWN SLO		FACILITY NUMBER:	405850034
ADMINISTRATOR:	KAREN ENCISO		FACILITY TYPE:	740
ADDRESS:	475 MARSH ST		TELEPHONE:	(805) 541-4222
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	100	CENSUS: 53	DATE:	02/08/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Darlene Markham, Administrator		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Due to staff negligence, the resident was injured

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) De Leon conducted an unannounced subsequent complaint visit to the facility above to issue final findings. LPA met with Darelne Markham and explained the purpose of the visit.

LPA Chavez started the investigation on 7/13/2023. LPA conducted interviews with staff, clients, and family members from 11:13am to 1:35pm, and reviewed relevant documents.

On the allegation: Due to staff negligence, the resident was injured. It was alleged in 2022 that Resident 1 (R1) sustained an injury due to staff negligence. CCL investigated this issue on a Case Management report on 3/23/2022. CCL received an incident reporting stating on 3/12/2022, Staff 1 (S1) answered R1’s call button page for assistance with wheelchair escort. R1 was not wearing their seat belt, and S1 pushed R1 quickly down a ramp.

Continued 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 29-AS-20230706125300

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 SLO	FACILITY NUMBER: 405850034
	VISIT DATE: 02/08/2024

NARRATIVE

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R1’s left foot got caught on the wheelchair tire. S1 tried to reach out to prevent R1 from falling, but R1 fell forward and landed on their knees, and R1’s face hit the floor. 911 was called and R1 went to the hospital. R1 was diagnosed with “Nasal bone fractures, fracture of finger of right hand, and fracture of maxilla.” Based on the evidence this allegation is deemed Substantiated at this time. However, a citation and civil penalty were already issued on 3/23/2022 so no citation will be issued on this report.

Exit interview conducted, copy of report and appeal rights printed for staff.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/06/2023 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20230706125300

FACILITY NAME:	AVILA SENIOR LIVING AT DOWNTOWN SLO		FACILITY NUMBER:	405850034
ADMINISTRATOR:	KAREN ENCISO		FACILITY TYPE:	740
ADDRESS:	475 MARSH ST		TELEPHONE:	(805) 541-4222
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	100	CENSUS: 53	DATE:	02/08/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Darlene Markham, Administrator		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Staff did not safeguard resident's belongings
Staff stole resident's money

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) De Leon conducted an unannounced subsequent complaint visit to the facility above to issue final findings. LPA met with Darlene Markham and explained the purpose of the visit. LPA Chavez started the investigation on 7/13/2023. LPA conducted interviews with staff, clients, and family members from 11:13am to 1:35pm, and reviewed relevant documents.

On the allegation: Staff did not safeguard resident's belongings. It was alleged that Resident 1 (R1)’s phone charger went missing. According the facility’s internal investigation, the charger disappeared when R1 moved rooms from one floor to another floor. R1’s family member stated the charger was present in R1’s room after the move. Staff searched for R1’s phone charger but were unable to find it. Staff stated R1 often forgets where they put things. The facility’s Activity Director replaced R1’s charger so they would have one. There was insufficient evidence to prove the facility did not safeguard the resident’s belongings. Based on the evidence this allegation is deemed Unsubstantiated at this time.

Continued 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20230706125300

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 SLO	FACILITY NUMBER: 405850034
	VISIT DATE: 02/08/2024

NARRATIVE

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On the allegation: Staff stole resident's money. It was alleged that Resident 1 (R1) won approximately $200 from playing bingo and it went missing. A family member of R1 was interviewed, who stated R1 hid their bingo money away on 7/12/23, and then could not find the money on 7/14/23. R1’s family member stated neither them nor R1 witnessed staff taking money, but could not find the money. R1 also moved rooms during this time, and moved to a different floor. Staff helped R1 search for the money, and indicated they know R1’s regularly hides money in certain locations, and also often forgets where they put things. Staff have also witnessed R1 pin money to the inside of their clothes before going on an outing, instead of using a wallet or purse. Staff also stated they have found R1’s money before while doing laundry and have returned it to R1. LPA attempted to interview R1 multiple times on 7/13/23, but R1 did not respond to LPA’s request for contact. The facility reported the missing items to local law enforcement, and conducted an internal investigation, but were unable to determine where the money went. The facility purchased a small safe for R1 to use inside their room, but R1’s responsible party refused the safe. Based on the evidence this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report printed for Administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC9099 (FAS) - (06/04)

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