405850034-4-19-2024-29-AS-KBUY-D5QMUU-20240529095542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 04/19/2024
Date Signed: 04/19/2024 03:35:53 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
04/16/2024 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20240416153430

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:	04/19/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Darlene Markham, Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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The Licensee is not answering to communication from the residents responsible party promptly or appropriately.

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 reviewed the emails that were sent back and fourth from the RP, Administrator and Licensee Pacifica LLC.

On the allegation: The Licensee is not answering to communication from the residents responsible party promptly or appropriately. On 03/13/2024 the RP of residents reached out to three individuals with the Licensee Pacifica LLC in an email and wanted a reply. On 03/27/2024 the RP had still not received a response and sent another email to the Licensee Pacifica LLC. On 03/28/2024 one of the Executive Continuous Improvement Specialist (CIS) reached out by text and email asking for the RP to come in and meet or set upa phone call. The RP responded on 03/28/2024 and asked for the Licensee to provide a written reply to the RP. 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: 04/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

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-20240416153430

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: 04/19/2024

NARRATIVE

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On 04/18/2024 the Administrator sent an email to the RP letting RP know that it is the Administrators job is to work with the RP to correct any issues or complaints at this level without getting the Licensee involved and if the RP was unhappy the RP could relocate the residents to a different facility. Again later that day the CIS of Pacifica reached out by email to the RP asking for the RP to work with the Administrator at the facility and provide questions the RP wants answered by email so the Licensee could get answers to the questions or issues so the Licensee could answer them appropriately. Based on the evidence of the emails communication from the RP's of the facility residents to the Licensee it has not been answered of 04/19/2024, 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: 04/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240416153430

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: 04/19/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/26/2024 Section Cited CCR 87468.1(a)(9)	1 2 3 4 5 6 7	(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to work with Licensee and respond to the residents RP's email promptly and appropriately to address and resolve any issues.
	8 9 10 11 12 13 14	Based on email communications records the Licensee failed to address correspondence sent on 03/13/2024 from the RP of the residents which poses a potential Personal Rights risk to residents in care.	8 9 10 11 12 13 14
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	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: 04/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

LIC9099 (FAS) - (06/04)

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