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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850480
Report Date: 01/12/2023
Date Signed: 01/12/2023 03:29:14 PM


Document Has Been Signed on 01/12/2023 03:29 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: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: 81DATE:
01/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Carl Meyer / AdministratorTIME COMPLETED:
11:30 AM
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 At 9:00am on 01/12/2023, Licensing Program Analyst (LPA) Jeffries arrived at the facility to conduct and unannounced annual, infection control visit. Upon arrival LPA was screened for COVID-19 protocols when entering the facility. LPA met with Administrator Carl Meyer and announced the reason for the visit as an annual, infection control inspection and additionally a subsequent initial complaint visit on a separate complaint.
At 9:45am Administrator and LPA conducted a cursory walking tour of the entire facility. LPA made observations of facility and entered several rooms and observed the following: LPA noted that there were hand sanitizers located throughout the facility for resident use, LPA noted that each bathroom entered there was liquid soap dispensers and paper towel dispensers. LPA observed a supply of PPE located in a closet on the first floor, and Administrator has an active order for additional PPE in process. LPA observed the kitchen and observed at least two days supply of perishable and at least seven days supply of non-perishable foods. LPA observed that both stair cases have a mobile fire escape chair at the top of each stair case. LPA noted that fire extinguishers are located throughout the facility are all in the green and tagged as currently checked with in the last 12 months. LPA noted that the facility is clean and in good repair and no exit was blocked. LPA tested the water in the facility and it was within regulation parameters when tested. LPA noted that there were no citations or violations noted during the cursory walk through tour of the facility with the Administrator at this time.
At 10:30am Administrator and LPA conducted the annual infection control portion of the annual inspection. During the infection control portion there were no citation, violations noted during the annual infection control module of the inspection. At this time there are no violations or citations issued on the annual inspection.

Exit interview, report read, signed and emailed.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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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