405850034-1-25-2024-29-AS-KBUY-D3TUAV-20240329152522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 01/25/2024
Date Signed: 01/25/2024 04:17:50 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
01/19/2024 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20240119140915

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: 49	DATE:	01/25/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Jutta Fairchild, Resident Services Director		TIME COMPLETED:	04:27 PM

ALLEGATION(S):

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Facility staff did not ensure facility was clean and in good repair
Insufficient staffing at facility

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 Jutta Fairchild Resident Care Director. Administrator Darlene Markham was away from the facility and could not met with LPA.

LPA requested the following documents: Resident Roster, Staff Roster with telephone numbers, Staff schedule for 12/2023-02/2024, and list of vacant positions.

LPA toured the facility with Jutta Fairchild at 9:53am.

On the allegation: Facility staff did not ensure facility was clean and in good repair. Based on the tour of the facility At 11:50am the storage room off the back patio had mold on the walls and is in need of cleaning and repair.
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: 01/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024

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 3

Control Number 29-AS-20240119140915

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: 01/25/2024

NARRATIVE

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At 11:53am LPA toured apartment 118, as this apartment shares a wall with the moldy storage area, the bathroom faucet needs to be fixed, the shower pan needs replacement it has two cracks in the bottom of the shower pan, the trim on the walls around are dirty and in need of replacement, the front door trim in rotting and in need of repair to the bottom area of doorway. At 12:00pm LPA toured apartment 202, the windows have leaked on and off over the past several years without repair, the wall below the middle window to the front of the building looks warped, the dry wall will need to be opened up to see if the dry wall needs to be replaced, the trim along the bottom of the floor under the windows has mold coming up the wall and is in need of cleaning and repair. At 12:04pm LPA toured the outside of the facility and some of the trim along the building is rotting and in need of repair. At 12:06pm the windows in the front entry 2nd floor have dust and debris in need of cleaning, at 12:07pm LPA toured the Atrium there are several noticeable leaks in the ceiling along the skylights and lights are in need of repair, paint is peeling, cracking and bubbling in a few areas and these areas are in need of repair. At 3:15pm the dining room wall trim next to the entry doors of the kitchen are in need of repair, and one of the kitchen storage rooms has had the dry wall replaced and still needs to be textured and painted. At 3:16pm apartment 205 is empty and has been remodeled the bedroom ceiling is in need of repair and facility maintenance assist was currently working in that area. Some of the other areas in the facility Apartment 255 and 256 had been recently repaired with dry wall, paint and trim in the bathrooms. The washer and dryer were currently replaced with brand new units in the resident laundry area on the 2nd floor and the 3rd floor resident laundry has two working washer and two dryers. The facility also had 3 working washer and dryers for doing facility laundering. At 3:55pm common area bathroom doors and door handles were dirty and in need of cleaning and sanitizing. Based on tour, LPA observation and the photographed evidence this allegation is deemed Substantiated at this time.

On the allegation: Insufficient staffing at facility. Based on the record review at 3:20 PM with staff schedules and interviews with staff the facility is currently in need of hiring a maintenance director, activity assistant/driver and a housekeeper. The facility has currently been advertising and hiring. The facility has currently offered positions to a caregiver in the wellness department, a kitchen staff server in the am, 1 am kitchen cook and 2 front desk positions, these positions will be filled once candidates can pass background clearance, medical/TB clearance and on-boarding with training being completed. Based on the evidence this allegation is deemed Substantiated at this time.

Exit interview conducted, deficiencies cited, 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: 01/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240119140915

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/25/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/26/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	(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:	1 2 3 4 5 6 7	Licensee agreed to have the mold inspected and eradicated from the facility, areas in need of repairs will have work compelted, areas in need of cleaning will be cleaned. Send Pictures of the completed work,Supervisors and managers will read/review and give a wrtitten understading of regulation 87303 and provide proof to CCL.
	8 9 10 11 12 13 14	Based on observation and photographs the Licensee did not comply with the regulation above, several areas in the facility have leaks, mold, rott and are in need of cleaning and repair which posses an immediate health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
Type B 02/01/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	(a)... staff shall be employed to ensure provision of personal assistance and care...Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agreed to continue highering until all open positions are filled and all staff currently being hired and working in all vacant posiitons, provide Schedules of all staffing to CCL for 02/2024, 03/2024 and 04/2024.
	8 9 10 11 12 13 14	Based on record and interviews the Licnesee did not comply with the regualtion above, The facility is not fully staffed which poses a potential safety and personal rights risk to residents in care.	8 9 10 11 12 13 14

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 Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024

LIC9099 (FAS) - (06/04)

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