405850034-2-8-2024-29-AS-KBUY-D2W44S-20240228174649

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 02/08/2024
Date Signed: 02/08/2024 04:09:10 PM

Unsubstantiated

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
02/07/2024 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20240207143519

FACILITY NAME:	AVILA SENIOR LIVING AT DOWNTOWN SLO		FACILITY NUMBER:	405850034
ADMINISTRATOR:	DARLENE MARKHAM		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:	04:15 PM

ALLEGATION(S):

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Staff did not provide a refund to resident or their authorized representative
Facility staff did not provide a written eviction notice to resident or their authorized representative

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) De Leon conducted a 10 day complaint visit to the facility above. LPA met with Darlene Markham and explained the purpose of the visit.

LPA De Leon requested the following records: Resident 1 (R1's) incident date, move out date, care conference date, Names and title present at the care conference, R1's care notes/charting for 11/2023-12/2023, copy of eviction letter or any letter issued to R1, Rent and Care fee invoices for 11/2023-12/2023, date R1's belongings were removed from apartment, Refund of rent and care fees amount and date provided, and R1's face sheet.

LPA De Leon reviewed records and conducted interviews around 12:15pm.

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)

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Control Number 29-AS-20240207143519

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 did not provide a refund to resident or their authorized representative. Resident 1 (R1) moved out of the facility on 12/07/2023, R1 had a change of condition and a care conference was held on 11/30/2023 where all parties had agreed that looking for relocation was the best outcome for the resident, no eviction was issued by the facility and no 30 day notice was provided by R1 or the responsible party, R1's family was looking for placement and a 1on1 care staff was provided by the family for R1 while R1 remained in the facility. On 12/01/2023 an assessment was conducted at the facility for possible placement of R1. R1 moved out of the facility on 12/07/2023 and all R1 belongings were removed out of R1' apartment on 12/11/2023. R1's rent and care fees had been paid up till 12/31/2023. The facility processed a refund for R1 on 02/06/2024 and R1's Responsible party verified the refund was received on 02/08/2024, therefore this allegation is Unsubstantiated at this time.

On the allegation: Facility staff did not provide a written eviction notice to resident or their authorized representative. LPA reviewed records and conducted interview which revealed that R1 had an incident on 11/26/2023 which lead to a care conference with facility and R1's family, relocation was agreed upon and a 1on1 care was set in place while R1 continued to live at the facility. Placement was found and R1 moved out of the facility voluntarily on 12/07/2023. R1's belongings were removed from the facility apartment on 12/11/2023 and a full refund of any fees paid after 12/11/2023 were refunded to R1's family. The facility did not issue an eviction to R1 at any time due to R1 care conference was in agreements that R1 would be relocated and no 30 day notice was required from the resident. Based on the evidence this allegation is 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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