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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801971
Report Date: 08/04/2023
Date Signed: 08/04/2023 05:15:47 PM

Document Has Been Signed on 08/04/2023 05:15 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:PASO ROBLES SENIOR LIVINGFACILITY NUMBER:
405801971
ADMINISTRATOR:ERIC BUNTEFACILITY TYPE:
740
ADDRESS:380 SCOTT STREETTELEPHONE:
(805) 227-4383
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 6CENSUS: 4DATE:
08/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Maryanne Del Monte / Care GiverTIME COMPLETED:
12:32 PM
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 At 10:45am on 08/04/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility based on a creditable witness report that residents were told by staff that they were not allowed to leave their rooms. LPA met with Care Giver Maryanne Del Monte, announced who he was and the reason for the visit.
At 10:30am LPA observed the main common living room area of the facility and did not observe any residents out in the common area of the facility. LPA asked Staff (S1), why there were no residents in the common area of the facility at 10:30am. S1 stated that they are all in their rooms. LPA noted that there are currently 4 residents residing at this facility at this time. LPA asked staff if residents were not permitted to be in the common area of the facility at any time. S1 stated that, "No, they prefer to be in their rooms sleeping or watching TV. (S1 stated): I would like it better if they were out here, so I could watch them while i prepared meals." LPA conducted interviews with all residents: Resident 1 (R1) and R2 were in room 1, both awake and watching TV. R1 stated that they are allowed to use the living room but they "like watching TV right here (Bedroom 1)" R2 was not responsive to LPA's questions and appeared to be sleeping prior to interview. LPA interviewed R3 in room 2.. R3 stated that they are allowed to use the facility at anytime they wanted to and no staff has told them they could not be in the common area at any time. LPA interviewed R4 in room 3, and stated that they are well cared for at this facility and is free to do what she pleases at the facility. R1, R3 and R4 all stated that there were no rules imposed on them as to accesses the common areas, bed room or any area of the facility. LPA did not get any response from R2.
At 11:09am LPA called Licensee/Administrator Eric Bunte by phone. LPA informed Licensee that he was at the facility on a Case Management visit based on a personal rights. LPA asked Licensee if they restricted any movement of any resident for any reason at this facility. Licensee denied denying resident movement or use of the common areas of the facility at any time. LPA and Licensee had a conversation about Resident Rights. LPA received permission from Licensee for Care Giver to sing report on his behalf as licensee was out of town.
At this time LPA concluded no findings and counseled staff, residents, and administrator/licensee on residents personal rights pertaining to movement in a facility.
Exit interview, report read, and report emailed.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2023
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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