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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850480
Report Date: 08/22/2023
Date Signed: 08/22/2023 11:42:20 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
10/17/2022 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20221017114617
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: 76DATE:
08/22/2023
UNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Administrator / Carl Meyer,TIME COMPLETED:
11:42 AM
ALLEGATION(S):
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Staff are denying resident indoor visitations.
Staff are not following resident's care plan.
Staff are not turning resident sufficiently.

INVESTIGATION FINDINGS:
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At 10:00am on 08/22/2023, 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 are denying resident indoor visitations.” It was discovered through interviews and documentation that, on 10/17/2022 at 3:03pm, the initial contact phone call with F1, it was discovered that F1 and facilities prior administrator (Ron Freeman) had made an agreement to circumvent COVID-19 screening protocols which were enforced during the time this complaint was submitted, which was address on a subsequent complaint (29-AS-20220615114827). Interviews on 10/21/2022 with S1-4 indicated that Mr. Freeman had knowledge and/or provided consent for F1 utilizing the first-floor exit door to enter the facility without screening for COVID-19 symptoms.

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: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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 3
Control Number 29-AS-20221017114617
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: 08/22/2023
NARRATIVE
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When the facility changed Administrators on July 18th of 2022, the new Administrator Carl Meyer informed F1 that all visitors, staff, and residents must be screened for COVID-19 at single entry point at the second-floor lobby door in order to access the facility due to CCLD and San Luis Obisbo County Public Health protocols. F1 stated that they didn’t believe in the screening during the initial contact phone call with LPA on 10/17/2022. LPA reviewed facility Guest Sign-Out Log from 09/19/2022 through 10/22/2022, LPA noted that there were 1044 visitor who were screened for COVID-19 protocols and singed in during that time period. F1 had one log of singing in on 10/20/2022 during the time period of 09/19/2022 through 10/20/2022. LPA also noted that in two interviews with F1 on 10/17/2022 and 10/20/2022, F1 stated that F1 had visited the facility to bring family member hygiene items and addressing staff were inside the facility room, however there was no indication that F1 had been screened and singed into the facility. LPA noted that F1’s family member room had a ground floor patio with a door that provide unscreened access. At 1:45pm on 10/20/2022, F1 contacted LPA by phone to protest COVID-19 screening while at the facility at the one access entry point for screening at the second-floor lobby door, LPA advised F1 that screening for COVID-19 in mandatory for all licensed facilities. LPA interviewed Administrator Carl Meyer on 10/21/2022, that stated access to facility was not denied to F1, F1 refused to be screened. Mr. Meyer also stated that F1 had been in the facility visiting family member prior to 10/20/2022. Based on interviews, documentation, and admission there is not enough evidence to support the allegation of, “Staff are denying resident indoor visitations.” and is unsubstantiated at this time.

As to the allegation of, “Staff are not following residents care plan.” It was discovered through interviews and documentation that, LPA reviewed R1’s most recent physicians orders dated 10/23/2022 that provide no indication in a change of status of R1. LPA reviewed R1’s service plan dated 08/05/2022 indicating that R1 “requires occasional hands-on assistance with transfers and or changes in position.”. LPA reviewed R1, LIC602 physicians report indicate that R1 requires help with bathing, dressing, care and toileting. LPA interview with R1 on 10/21/2022, R1 stated that they had never had to wait on staff for assistance and staff was always there when R1 called on staff for assistance. R1 stated that all R1’s needs are being met and the care at the facility is great. R1 denied lack of care or following care plan. Interviews with S1-S4 did not reveal any staff not meeting residents needs. Interview with Administrator Carl Meyer on 10/21/2022, stated that Physical Therapy (PT) was canceled by F1 and not the facility, however PT session would be reevaluated for R1 at physicians’ appointment on 10/23/2022. At this time there is not enough evidence to support the allegation of, “Staff are not following residents care plan.” and is unsubstantiated at this time.
CONTINUED on LIC9099-C
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20221017114617
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: 08/22/2023
NARRATIVE
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As to the allegation of, “Staff are not turning resident sufficiently.” It was discovered through documentation and interviews that, LPA reviewed R1’s most recent physicians orders dated 10/23/2022 that provide no indication in a change of status of R1. LPA reviewed R1’s service plan dated 08/05/2022 indicating that R1 “requires occasional hands-on assistance with transfers and or changes in position.”. LPA reviewed R1, LIC602 physicians report indicate that R1 requires help with bathing, dressing, care and toileting. R1 was interviewed on 10/21/2022 stated that they had never had to wait on staff for assistance and staff was always there when R1 called on staff for assistance. R1 stated that all R1’s needs are being met and the care at the facility is great. R1 denied lack of care or following care plan. R1 denied having pressure wounds of any kind. Interviews with S1-S4 did not reveal any staff not meeting resident’s needs. On 10/23/2022 LPA reviewed Physicians orders and found not changes and no new diagnosis. Based on interviews and documentation there is not enough evidence at this time to support the allegation of, “Staff are not turning resident sufficiently”. and is unsubstantiated at this time.


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: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3