405850034-5-10-2024-29-AS-KBUY-D5GUE6-20240521153038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 05/10/2024
Date Signed: 05/10/2024 03:26:55 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
05/02/2024 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20240502101705

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: 47	DATE:	05/10/2024
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Darlene Markham, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Illegal Eviction

INVESTIGATION FINDINGS:

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

On prior visit LPA requested a resident roster and a staff roster with telephone numbers.

LPA De Leon received an eviction notice on 04/24/2024 at 4:30 pm for Resident 1 (R1). The facility gave the reason for eviction: If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident.

LPA De Leon emailed the Administrator and asked for the following records: LIC 602A physicians report old and new, Pre-Placement Appraisal, Functional Capabilities Assessment, Charting notes, Doctor notes, Home Health agency and phone number, Resident Assessment and Needs and Services Plans to determine if R1 had any need not previously identified after admission of 07/01/2022 to the facility.

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: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

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-20240502101705

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: 05/10/2024

NARRATIVE

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LPA De Leon determined after review of pre-placement appraisals and the LIC 602A physicians reports that R1's needs were all identified in the records prior to R1's Admittance into the facility. R1 has had changes to R1's care plan, points and levels and the facility has been able to meet the needs of the resident from 07/01/2022-04/23/2024.

LPA De Leon emailed the facility on 05/01/2024 that the eviction was unlawful and needed to be rescinded at this time. The facility emailed back to LPA that they do not agree with the decision to rescind the eviction notice because the facility believes R1 exceeds the facilities levels of care that the facility can safely provide. The facility will rescind the eviction today while the facility gathers more information, speaks with their legal team and the fire marshal.

On 05/01/2024 later in the afternoon this complaint was received by CCL of an illegal eviction for R1.
R1 and Administrator confirmed on 05/02/2024 the eviction has been rescinded.

Based on the evidence this allegation is deemed Substantiated at this time.

Exit interview conducted, deficiency cited, copy of report and appeal rights 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: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240502101705

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: 05/10/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/10/2024 Section Cited CCR 87224(a)(4)	1 2 3 4 5 6 7	(a) The licensee may evict a resident... (4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator had already rescinded evcition on 05/02/2024. POC cleared at time of visit.
	8 9 10 11 12 13 14	Based on record review the Licensee did not comply with the regulation above R1 did not have a need not previously identified after admission which poses a potential personal rights risk to reisdents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

LIC9099 (FAS) - (06/04)

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