<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850480
Report Date: 07/27/2023
Date Signed: 07/27/2023 10:02:47 AM

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
06/15/2022 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20220615114827
FACILITY NAME:OAKS AT PASO ROBLES, THEFACILITY NUMBER:
405850480
ADMINISTRATOR:FREEMAN, RONALDFACILITY TYPE:
740
ADDRESS:526 S RIVER ROADTELEPHONE:
(805) 239-5851
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:120CENSUS: 87DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
09:30 PM
MET WITH:Administrator / Carl MeyerTIME COMPLETED:
11:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not follow protocols to prevent the spread of COVID-19.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 9:32am on 07/27/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to issue final findings to the allegations above. LPA met with Administrator Carl Meyer, announced who he was and the reason for the visit.

As to the allegation of, “Staff do not follow protocols to prevent the spread of COVID-19. It was discovered through interviews on 10/21/2022 and admission on 10/17/2022, that Staff 1 through 4 sated that, Administrator Ron Freeman agreed to allow a Family member (F1) to enter through the first-floor exit door during the months of June and July of 2022 during COVID-19 screening protocols, by agreeing to leaving fist floor exit door open and/or having staff open door for F1, circumventing applicable COVID-19 screening protocols during this time, the single entry point was at the second floor lobby door of the facility where screening was to take place.

Report continued on LIC9909-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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 5
Control Number 29-AS-20220615114827
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: 07/27/2023
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
26
27
28
29
30
31
32
During a phone call on 10/17/2022 at 3:03pm LPA spoke with F1 related to a separate complaint, during this phone call F1 stated, “Administrator gave me permission to enter on the first floor.” and “staff has let me in the first floor exit or its left unlocked.” Based on interviews, and admission, the allegation of “Staff do not follow protocols to prevent the spread of COVID-19”. Is substantiated at this time.

Report read, citation issued, appeal rights and report provided

Continued on LIC9099-A
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
06/15/2022 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20220615114827

FACILITY NAME:OAKS AT PASO ROBLES, THEFACILITY NUMBER:
405850480
ADMINISTRATOR:FREEMAN, RONALDFACILITY TYPE:
740
ADDRESS:526 S RIVER ROADTELEPHONE:
(805) 239-5851
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:120CENSUS: 87DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
09:30 PM
MET WITH:Administrator / Carl MeyerTIME COMPLETED:
11:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Insufficient staff to meet resident needs.
Facility is not kept clean and sanitary.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 9:30am on 07/27/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to issue final findings to the allegations above. LPA met with Administrator Carl Meyer, announced who he was and the reason for the visit.
As to the allegation of, “Insufficient staff to meet residents needs.” It was discovered through documentation and interviews that S1-4 stated that there is enough staff to cover, S3 added, “because of COVID, sometimes it gets overwhelming.” LPA interview with Administrator Carl Meyer on 10/21/2022 indicated that the facility has been able to maintain staff coverage during recent COVID-19 outbreaks. LPA reviewed facility schedule for the months of June and July of 2022 and found there to be sufficient staff coverage during this time period. At this time there is not enough evidence to support the allegation of, "Insufficient staff to meet residents needs.” and is unsubstantiated at this time.

CONTINUED on LIC9099-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: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20220615114827
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: 07/27/2023
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
26
27
28
29
30
31
32
 As to the allegation of, “Facility is not kept clean and sanitary.” I was discovered through interviews, documentation, and observation that in interviews on 06/20/2022, with S1, 2, 3, and 4 that there were no issues or complaints about the cleanliness of the facility and no resident had complaint to S1-4 about facility cleanliness. Interviews of Residents 1-6 did not think that the facility had any issues with cleanliness, all 6 residents were happy with how clean the facility we kept. LPA conducted a physical tour of the entire facility on 06/20/2022, and on 10/21/2022, LPA conducted a second observational cursory tour of the facility, facility main kitchen, and memory care kitchenette and found the facility to be clean and sanitary on both observational tours. LPA reviewed staff schedule and found there to be sufficient kitchen and housekeeping staff during the months of June and July 2022. At this time there is not enough evidence to support the allegation of, “Facility is not kept clean and sanitary.” and is unsubstantiated at this time.



Exit interview, report read, report singed, citation issued, report and appeal rights provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20220615114827
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2023
Section Cited
CCR
87468.1(a)(2)
1
2
3
4
5
6
7
Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
1
2
3
4
5
6
7
Administrator who broke COVID-19 screening protocols is no longer at this facility, additionally the COVID-19 screening has been rescinded, therefore the POC is cleared at this visit,,
8
9
10
11
12
13
14
This requirement was not met by evidence of Administrator allowing F1 to circumvent COVID-19 screening for two months or more, which posed a potential health risk to all 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 BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5