405850034-8-14-2024-29-AS-KBUY-D8MUTM-20240830155209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850034
Report Date: 08/14/2024
Date Signed: 08/14/2024 04:57:23 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
08/07/2024 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20240807134014

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: 44	DATE:	08/14/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Darlene Markham, Administrator		TIME COMPLETED:	05:05 PM

ALLEGATION(S):

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Staff did not comply with emergency disaster plan requirements.

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, Administrator and explained the purpose of the visit.

LPA requested the following records: Emergency Disaster Plan, Emergency Binder with Policy and procedures for alarms, Staff Roster with Telephone numbers, Resident Roster, Invoice for Alarm Troubleshoot, Copy of facility sketch with emergency exits with Rally Points, Fire Inspection Report, Fire Sprinkler Report, and any invoices or inspection reports for 2024.

LPA interviewed Staff at 10:55am, 11:07am, 11:57am, 12:35pm, and 12:56pm. LPA interviewed Residents at 2:18pm, 2:30pm, 2:40pm, and 2:44pm.

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: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

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-20240807134014

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: 08/14/2024

NARRATIVE

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On the Allegation: Staff did not comply with emergency disaster plan requirements, LPA conducted interviews with staff which revealed the facility fire alarms sounded through out the building on 07/18/2024 around 10:30am. Staff said the hood above the stove in the kitchen turned off during cooking, light smoke made the alarm go off, which made the whole building alarms go off. The staff and residents in the common areas started to evacuate assisted by staff to the nearest exiting location.

LPA interviewed residents which revealed residents that remained in apartments were told on prior fire drills to remain in apartments until staff assisted them. Residents in the common area were assisted by staff to evacuate. After the alarms were turned off the staff and residents that were evacuated were told it was a false alarm and could return inside the building. The residents that remained in their apartments were never notified that it was a false alarm and when residents finally exited apartments found out by staff and other residents it had been a false alarm.

LPA reviewed the emergency disaster plan and the facility did fail to communicate to all residents regarding it being a false alarm. Staff that had assignments during an emergency or disaster did not follow all assigned tasks. The staff did not go door to door, call or hang signs around the facility for residents in apartments to know it was a false alarm. Communication to the residents was not done adequately therefore this allegation is deemed Substantiated at this time.

Exit interview conducted, deficiency cited, copy of report an 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: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240807134014

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: 08/14/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/22/2024 Section Cited CCR 87212(b)(2)(F)	1 2 3 4 5 6 7	(b)... (2) Plan for evacuation including:(F) Supervision of residents during evacuation or relocation and contact after relocation to assure that relocation has been completed as planned. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Administrator agreed to update facility sketch's, place updated sketch and assembly points in main hallways, communicate to residents emergency plan and assembly points, make sure all staff are up to date on annual training requirements for emergencies disaster plan.
	8 9 10 11 12 13 14	Based on interviews and record review the licensee did not comply with the regulation above Residents were left in rooms with no communication about a false fire alarm which poses a potential health, safety and personal rights risk to residents 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: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

LIC9099 (FAS) - (06/04)

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