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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850480
Report Date: 06/10/2024
Date Signed: 06/10/2024 10:50:43 AM

Unsubstantiated


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
01/06/2023 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20230106094616
FACILITY NAME:OAKS AT PASO ROBLES, THEFACILITY NUMBER:
405850480
ADMINISTRATOR:PETER J BONILLAFACILITY TYPE:
740
ADDRESS:526 S RIVER ROADTELEPHONE:
(805) 239-5851
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:120CENSUS: 87DATE:
06/10/2024
UNANNOUNCEDTIME BEGAN:
07:23 PM
MET WITH:Administrator - Carl MeyerTIME COMPLETED:
11:14 PM
ALLEGATION(S):
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9
Facility staff yell at residents.
Facility staff inappropriately handled resident in a rough manner.
Facility staff do not adequately supervise residents.
Facility staff do not treat residents with dignity and respect.
INVESTIGATION FINDINGS:
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At 8:30am on 06/10/2024, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to delivering final findings to the allegations to this complaint, as well as a second complaint, and a complaint visit on a thrid complaint. LPA met with facility Administrator, Carl Meyer, announce who he is and the reason for the visit.

As to the allegations, “Facility staff yell at residents.” It was alleged that a caregiver Staff 7 (S7) yelled at residents. It was discovered through documentation, and interviews that, On 01/12/2023 interviews of S1-S6 all stated that they had never heard S7 raise their voice or yell at residents. In interviews with R1 – R16 on 01/12/2023, all residents denied any staff ever yelling or raising their voice with residents. LPA reviewed facility only termination notice during this time frame (January 2023 – March 2023) and there was only one termination of staff due to an unrelated contractual conflict. At this time there is not enough evidence to support the allegation of, “Facility staff yell at residents.” And is unsubstantiated at this time.
CONTINUED on LIC-9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2024
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 2
Control Number 29-AS-20230106094616
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: OAKS AT PASO ROBLES, THE
FACILITY NUMBER: 405850480
VISIT DATE: 06/10/2024
NARRATIVE
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As to the allegation of, “Facility staff inappropriately handled resident in a rough manner.” It was alleged that S7 pulled a pencil out of the contracted hand of R14 so hard the pencil cracked and broke. It was discovered through documentation and interviews on 01/12/2023 in interviews of S1 and S2, both stated they were on duty at the time of the alleged incident, both present during the incident in question, and both S1 and S2 stated that the pencil was broken with a sharp point while in the hand of R14, both stated that S7 pulled the broken pencil out of the hand of R14 for their safety. Both S1 and S2 describe the incident as careful and ethically conducted for the safety or R14. LPA reviewed facility document of submitted Unusual Incident Report (LIC624) dated 01/05/2023 indicating S7 retrieving broken pencil to prevent possible injury of R14’s hand, with no further incident and facility charting notes dated 01/13/2023 at 3:05pm corroborating LIC624. Administrator stated internal facility inquiry with all staff involved revealed same conclusion. Interviews on 01/12/2023 of R1-R12 all stated that they had no issues with staff and feel safe in this facility. On 01/12/2023 interviews of S1-S6 all stated that they had never heard S7 raise their voice or yell at residents. At this time there is not enough evidence to support the allegation of, “Facility staff inappropriately handled resident in a rough manner,” and is unsubstantiated at this time.
As to the allegation of, “Facility staff do not adequately supervise residents.” and “Facility staff do not treat residents with dignity and respect.” It was alleged that, resident was asleep at the table with her hand in her plate of food, and staff are eating take-out food same dining rooms with residents.” It was discovered through interview on 01/12/2023 of S1-S6 there is always enough staff and facility calls temp. services for staff they the facility is short staffed. S1-S6 all stated that if a resident falls asleep in the common areas including the dinner table, they let them sleep unless they are in a hazardous position or subject to falling out of the chair. Interviews with S3-S6 all stated that staff do not eat in the same area as the residents. Interviews on 01/12/2023 of R1-R12 all stated that they had no issues with staff and feel safe in this facility. At this time there is not enough evidence to support the allegations of, “Facility staff do not adequately supervise residents.” and “Facility staff do not treat residents with dignity and respect.” and both are unsubstantiated at this time.

Exit Interview, report read, and report provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2024
LIC9099 (FAS) - (06/04)
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