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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850524
Report Date: 08/26/2024
Date Signed: 08/26/2024 12:16:01 PM

Document Has Been Signed on 08/26/2024 12:16 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:ROBLES RANCH MENTAL HEALTHFACILITY NUMBER:
405850524
ADMINISTRATOR/
DIRECTOR:
ASHLEY, CHEREEFACILITY TYPE:
772
ADDRESS:175 CRIPPLE CREEK ROADTELEPHONE:
(831) 245-7736
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 6CENSUS: 0DATE:
08/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:01 AM
MET WITH:Cheree Ashley - AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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At 9:30am on 08/26/2024, Licensing Program Analyst (LPA) Jeffries arrived at the schedule time to conduct the facility pre-licensing inspection visit LPA met with Administrators, Cheree Ashley and William Harris, announced who he is and the reason for the visit.
Administrators and LPA conducted a walking tour of the facility and facility grounds. LPA noted that the facility is located in a rural area outside the Paso Robles city limits. LPA noted that entering the facility there is a long gravel driveway with a fence that requires a code for entrance. The facility is located on an expansive 5 plus acres and had two buildings. The main building has 4 bedrooms, of which bedroom 1 and bedroom 4 are designated as duel resident occupancy; bedrooms 2 and 3 are designated as single resident occupancy. There is a large kitchen that opens up to a living room and two additional rooms that will be therapy/activity rooms. There is a laundry room that will be open to residents and facility will facility the use of chemical detergents that will be locked in laundry room storage. There is ample outside patio, that is covered for shade, with very large backyard. The is a hot tub with a locked cover, there is a full sized swimming pool with a key locked controlled cover that covers the entire pool. To the north side of the main building is a building that will serve as the facility office. This building has a kitchenette, office room and bathroom. Per licensee, no staff or resident will reside in the bedroom in the office building. LPA noted that one bedroom was staged for pre-licensing inspection. LPA noted that all bedroom will meet the required furnishings of bed, chair, lamp and 3 required drawers with closet. LPA noted that all bedrooms have lighting and bedding linins per regulation. LPA noted that the facility has smoke detectors throughout the facility that are hard wired and the hallway smoke detectors are dual smoke and carbon monoxide detectors. LPA observed a fire extinguisher that is primed in the green and tagged current. Facility will keep medication locked in the office building under three levels of locks. LPA noted that the facility has a complete first aide kit per regulations. LPA noted that the facility is clean and in good repair. Well water report was conducted on 02/07/2024 from Miller Drilling of Templeton California (invoice#24-0636).
Administrators and LPA conducted full control tools review for Social Rehabilitation Facility (772) and a full review of Component III training was also competed as part of this pre-licensing inspection.
Exit interview, report read, and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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