405850480-5-23-2024-29-AS-KBUY-D6F4VL-20240620192632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850480
Report Date: 05/22/2024
Date Signed: 05/23/2024 10:05:02 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
01/24/2023 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20230124131216

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: 85	DATE:	05/22/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Administrator, Carl Meyer		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff allow resident to continue self-neglect.

INVESTIGATION FINDINGS:

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On 05/23/2024, at 8:30am, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to issue final findings to the allegation to this complaint. LPA also issue final findings on additional complaint and conducted initial investigation visit on a third complaint on this visit. LPA met with Administrator, Carl Meyer, announced who he is and the reason for the visit.

As to the allegation of, “Staff failed to observe resident’s continued self-neglect.” It was alleged that, Resident (R1) smells of urine and is generally observed to be wet with urine.” It was discovered through interviews, observations, and documentation, that on 01/26/2023, LPA conducted an in-room interview with resident 1 (R1). R1 stated that they did have an incontinence problem and stated it was due to, “not being able to move as fast as (they) use to.” R1 stated that staff is always there to help, however R1 also stated, “I am still independent and use their (staff) help when I need to.” R1 stated that they have been buying items on Amazon lately and have not thrown some of the packaging away.
CONTINUED on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230124131216

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: 05/22/2024

NARRATIVE

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R1 stated that, they did not want staff to touch the items in (their) room. R1 also stated that they feel safe and cared for in the facility and had no issues with the facility. In interview of Staff 1-4 (S1, S2, S3, and S4) on 01/26/2023, all stated that they have prompted R1 for assistance and help and R1 refused help with cleaning and hygiene. On 01/26/2023, LPA made observations of R1’s room and noted at least 4 Amazon packages in R1’s room, LPA noted that there was no apparent odor emanating from in or around R1’s room and no incontinence issues during the interview and visit on 01/26/2023. Interview with Administrator on 03/23/2023, LPA interviewed Administrator, who stated, R1 now has additional cleaning support, and additional incontinence support as part of R1’s care plan. On 03/23/2023, LPA also viewed fire extinguishers throughout the facility to be in regulation compliance (87203), staffing to be in sufficient numbers and resident counsel meeting posted monthly with scheduled meeting posted on facility bulletin board. At this time there is not enough evidence to support the allegation of, “Staff failed to observed resident’s continued self-neglect.” and is unsubstantiated at this time.

Exit interview, Report read, report singed, 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: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC9099 (FAS) - (06/04)

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