405850480-2-26-2024-29-AS-MJES-D2TVNN-20240226153525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405850480
Report Date: 02/26/2024
Date Signed: 02/26/2024 03:36:20 PM

Document Has Been Signed on 02/26/2024 03:36 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, THE		FACILITY NUMBER:	405850480
ADMINISTRATOR:	CARL MEYER		FACILITY TYPE:	740
ADDRESS:	526 S RIVER ROAD		TELEPHONE:	(805) 239-5851
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	120	CENSUS: 86	DATE:	02/26/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Administrator, Carl Meyer		TIME COMPLETED:	04:00 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 9:50am on 02/26/2024, Licensing Program Analyst (LAP) Jeffries arrived unannounced at the facility to conduct the facility annual inspection. LPA met with Administrator Carl Meyer, announced who he is and the reason for the visit. Administrator and LPA conducted a physical walking through tour of the full facility and the facility's outside perimeter. LPA noted that the facilities administrator is collaborating with the city of Paso Robles to address a water run off from recent storms that effect the sidewalk and road on the west side of the facility. Administrator plans on mitigating the extra rain water run off with diverting flow from the south driveway. LPA was able to observed an unobstructed pathway in the front of the facility and suggested to the administrator to provide warnings to residents and staff during heavy rain run off conditions. LPA noted that the remainder of the outside area of the facility is clean and in good repair. The facility is a 3 story building with 97 resident rooms of which 24 are memory care rooms. All rooms have an on suite bathroom, and assorted rooms share a "jack and Jill' type bathroom. The resident rooms are assorted number of one bedrooms, and suites. There is one room of the facility that is a 2 bedroom configuration. On each floor and in the memory care unit there are rooms for social and recreation gatherings. The memory care unit has a courtyard area for resident to be outside, there are furnishing with umbrellas to protect residents, guest and staff from outside elements. Each floor has multiple community use restrooms, laundry rooms, snack bar and refreshment areas, and an assortment of recreation rooms such as painting room, workout equipment room, and television rooms. There are multiple offices, storage areas, and utility closets throughout the facility. The facility has two stairwells location on the north and south sides of the facility both have a fire evacuation chair located at the top of each stairwell. There are two elevators located in the central areas of the facility. The facility has a large reception area for guest and visitors. The kitchen and dining room are located on the second floor (ground level from the east side main entrance). The memory care unit has a self contained kitchenette. LPA noted that during the physical walking tour of the CONTINUED on LIC-809-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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: 02/26/2024

NARRATIVE

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facility LPA was able to audit several resident rooms. LPA noted that all rooms were properly equipped by regulation standards. LPA noted that all appliances were in good working condition on the temperature of the facility was regulated at 72*(f), this day the temperature outside was 51*(f) when LPA entered the facility. LPA noted that all assisted grab bars were firmly secured on the walls, LPA noted that the facility had at least 8 fire extinguishers on each floor, all of which were tagged current and in the green pressurized reading. LPA observed most recent fire inspection report from Alpha Fire Unlimited dated 02/15/2024 which indicated that the fire detection and water distribution system pass pressurization test and is functioning properly. LPA noted that all hallways, and entrenches were free and clear of obstacles. LPA noted that this facility has its own on site emergency generator and LPA observed ample amount of emergency water on the first floor. LPA observed at least two days of perishable and at least seven days of non-perishable foods on hand in the kitchen, Administrator and LPA reviewed menu requirements and screening procedures for doctors ordered, and prefrontal diets.
LPA conducted a sample audit of resident and staff files. LPA noted that Resident 1 (R1) did not have a Tuberculosis Test on either of the LIC602s in their file and a citation was issued. LPA noted that all other mandated forms were current in resident and staff files. LPA screened all staff criminal record clearance and all staff working are cleared.
Administrator and LPA conducted a complete review of all of the annual care tools modules. LPA noted that the only violation was the citation mentioned above and was cited in the care tools module form. LPA noted that there were no other citations, violations or technical issued as a result of this annual facility inspection,

Exit interview, citation issued, appeal rights, and report provided.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 02/26/2024 03:36 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87458(b)(1)

Medical Assessment

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC809 (FAS) - (06/04)

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