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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801971
Report Date: 07/18/2023
Date Signed: 07/18/2023 04:04:31 PM


Document Has Been Signed on 07/18/2023 04:04 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:PASO ROBLES SENIOR LIVINGFACILITY NUMBER:
405801971
ADMINISTRATOR:ERIC BUNTEFACILITY TYPE:
740
ADDRESS:380 SCOTT STREETTELEPHONE:
(805) 227-4383
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:6CENSUS: 4DATE:
07/18/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Eric Bunte / LicenseeTIME COMPLETED:
04:00 PM
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 At 1:00pm on 07/18/2023, Licensing Program Analyst (LPA) Jeffries returned unannounced to complete the annual inspection started on 07/06/2023. LPA made contact with Licensee Eric Bunte and announced who he was and the reason for the visit.

At 1:20pm, Licensee and LPA conducted a constructive physical tour of the facility. LPA noted that the facility is a three bedroom, double client occupancy, one shared bathroom with kitchen, dining/living room area, and outside area with a 14'x16' pergola with ample seating for residents outside with cover for shade. LPA noted that Licensee has applied with the city of Paso Robles for a construction permit, submitted to Licensing for approval to convert the living room on current facility sketch to an additional double occupancy bedroom pending fire clearance approval. That area of the facility is currently not in use until fire clearance approval is met. LPA noted that the facility has at least 2 days of perishable and at least 7 days of non- perishable foods on hand. LPA noted that each room is properly equipped with storage, lighting and linin to meet regulation requirements. LPA noted that the facility is equipped with working smoke detectors throughout the facility and fire extinguisher is primed in the green indicating working status. LPA noted that there is a staff residence on the second floor of the facility and has a gate at the bottom of the stairs for staff entrance only. LPA noted that the staff, resident files, and medication are in a locked cabinet. LPA conducted a sample medication audit and found no errors. LPA did not find any violations during the constructive physical tour.

At 2:00pm Licensee and LPA conducted a review of the care tools modules. LPA noted that care tools module had a computer malfunction on module 8 of 12 care tool modules. LPA reviewed the last 4 care tool modules verbally with Licensee. During the review of all 12 care tool modules, LPA found no violations or deficiencies. At this time the annual inspection revealed no violations or citations.

Exit interview, report read, report singed and report provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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