405850480-2-17-2021-29-AS-MJES-BYBVJG-20210217152842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405850480
Report Date: 02/17/2021
Date Signed: 02/17/2021 03:30:17 PM

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:	OAKS AT PASO ROBLES, THE		FACILITY NUMBER:	405850480
ADMINISTRATOR:	FREEMAN, RONALD		FACILITY TYPE:	740
ADDRESS:	526 S. RIVER ROAD		TELEPHONE:	(805) 239-5851
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	120	CENSUS: 0	DATE:	02/17/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Ronald Freeman/Administrator		TIME COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 10:00am on 02/17/2021, Licensing Program Analyst (LPA) Mark Jeffries conducted a Pre-Licensing Inspection with Administrator Ronald Freeman. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted virtually with the use of "FaceTime". An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL). A Fire Clearance was approved on 01/12/2021. This facility is approved for a total capacity of 120 residents, 108 can be non-ambulatory and 12 can be bedridden. This facility is a 3 story building with a total of 97 rooms. Seventy-three (73) rooms located throughout all three floors for assisted living, twenty-four (24) single occupancy rooms are located on the second floor which are designated for Memory Care. The facilities main entrance is at the rear of the building, entering into the second floor lobby. Each floor has rooms for social gatherings, recreation, dining areas, administrative offices, laundry and supply. There are 4 stairwells all equipped with emergency stair chairs. There were two elevators with weight capacity's of 3500 pounds each. All major utility shut offs were identified and located. There were no bodies of water observed on this inspection. The facility has two balconies that access the outside in the assisted living areas and a outside walk way, all free of hazards and obstructions. The memory care unit, has 4 exit doors all key and number pin coded for exit and entry for delayed egress. The visitors entrance/exit to memory care has a stage room in-between two separate thresholds door exits/entrances. Memory care has a warming kitchen, dining area, recreation room, hair solon, medication room and charting room for secure information and medications. There are 4 exits in the memory care unit, all keyed and pin number coded. The memory care residents will all be equipped with location pendents to comply with delayed egress. There is an enclosed open area with large windows on both sides of the area and two exit doors. The facility has a fire sprinkler system built into the building, fire detectors/carbon monoxide are evenly spaced out throughout the building approximately 10'-15' feet apart. Each floor has 6 or more fire extinguishers spaced out throughout each floor. Continued on LIC809-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKS AT PASO ROBLES, THE	FACILITY NUMBER: 405850480
	VISIT DATE: 02/17/2021

NARRATIVE

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There is a water utility room to monitor the regulated temperature of the water to automatically maintain regulated water temperature parameters. All hallways, and rooms visited were free of any hazards and/or obstacles. Bedrooms had safe, appropriate and met regulation requirements. Bathrooms all had sturdy grab bars and non-slip floors in showers. Bedrooms observed had all necessary storage, bedding and free of any observable hazards. All areas of the facility had emergency lighting and zoned climate control for every separate space. Each room had individual climate control and LPA observed facility temperature to be 69* Fahrenheit at the time of FaceTIme inspection. Two medication rooms and a charting room will be secured by lock to facilitate secure medication and documentation areas for the facility. The industrial kitchen was in fully equipped and LPA viewed on of the walk in refrigerators with a supply of food, duration and census is zero at this time so no calculation was estimated at this FaceTime inspection. The warming kitchen in the memory care unit was well equipped. Both Kitchens had new, appropriate and operational industrial appliance. The facility has a new multiple passenger bus for transportation use. There are no open bodies of water and outside areas have shaded seating for resident use.
Weekly menus are posted at the dining areas as well as displayed on monitors throughout the facility. All required documentation, emergency contacts and emergency reporting posters are posted in the hallway across from the mailboxes on the second floor common area.
The facility is of new construction and all areas were new, clean and operational as viewed by LPA over FaceTime pre-licensing inspection. One point of note from LPA to the Administrator; All common areas need to have furniture seating areas moved to provided at least six feet separation in light of COIVD-19 precautions. Administrator agreed and noted that marketing pictures took place day of inspection and all common area seating will be adjusted to provide social distancing in accordance with COVD-19 prevention recommendations and COVID-19 related posters will be posted at every entrance and hand washing posters in each bathroom.
No other corrections are needed at this time.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating under the new license number until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview conducted and a copy of this report was provided to Administrator via email for signature.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

LIC809 (FAS) - (06/04)

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