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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850034
Report Date: 03/11/2024
Date Signed: 03/11/2024 06:01:42 PM


Document Has Been Signed on 03/11/2024 06:01 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: 48DATE:
03/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Darlene Markham, AdministratorTIME COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) De Leon conducted a case management visit-deficiency to address a plan of correction that has not been completed. LPA met with Darlene Markham and explained the purpose of the visit.

On 01/25/2024 LPA cited the facility on a Substantiated Complaint visit for 87303(a).

LPA has conducted several visits to the facility and the physical plan has not been repaired.

LPA took a tour of the facility today and a few of the repairs have not been completed.

The following work is still in need of repair:
Storage area is in need of drainage, Apt 202 has had an air test done for mold that came out negative, the company opened back up the wall and put equipment in the room for several days to dry it out and the company returned on Wednesday last week to test the apartment again but the facility has not heard back from the company about the outcome of the test or the plan going forward for this apartments required repairs, the roofs leaks over apt 202-205 have not been completed, currently 1 washer is out of order and in need of repair the facility has a technician coming out tomorrow for this repair.

Exit interview conducted, deficiency cited, civil penalty assessed for repeat violations, copy of report and appeal rights printed for Administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De LeonTELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 03/11/2024 06:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2024
Section Cited
CCR
87303(a)

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(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
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Administrator agreed to get repairs done to apt 202, storage area and the broken washer, send pictures to CCL of all work compelted along with work orders, bids, estimates, invoices and paid invoices of the work completed to CCL.
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Based on observation and photographs the Licensee did not comply with the regulation above, The storage room needs drianage, the washer is out of order, work has not been completed on apt 202, roof leaks and wood rotted has not been replaced which posses an immediate health, safety and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De LeonTELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2024
LIC809 (FAS) - (06/04)
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