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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801971
Report Date: 08/12/2024
Date Signed: 08/12/2024 01:11:25 PM

Document Has Been Signed on 08/12/2024 01:11 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/
DIRECTOR:		ERIC BUNTEFACILITY TYPE:
740
ADDRESS:380 SCOTT STREETTELEPHONE:
(805) 227-4383
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 6CENSUS: 5DATE:
08/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Licens LPA interviewed 3 staff and 3 Residents, 2 Residents declined interviews.ee, Eric BunteTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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 At 12:00 pm on 08/12/2024, Licensing Program Analyst (LPA) Jeffries arrive at the facility and announced who he is and the reason for the visit. LPA met with Licensee/Administrator Eric Bunte and explained the reason for the visit.

Licensee and LPA conducted a walking tour of the facility. The facility is a 5 bedroom, 3 bathroom with kitchen, small living room and dining. Two bedroom have double Resident occupancy and the other 2 Resident bedrooms are single Resident occupancy. All three facility bathrooms have hand sanitizer and paper towels. The 5th bedroom and third bathroom are staff live-in quarters and are located on the second floor of the facility. LPA observed the medication closet in hallway past the kitchen and dining room area and staff and resident files are also kept in the same closet. LPA observed all required postings in centralized hallway of the facility. LPA observed more than a two day supply of non perishable foods and more than a seven day supply of perishable foods on hand at the facility for staff and 6 residnets. LPA checked fire detectors and carbon monoxide detectors all in good working condition. LPA observed and ample amount of PPE supplies. LPA noted that all exits, hallways and doors are free from obstructions. LPA did not discover any visible deficiencies or citations at this time during the facility tour.

LPA and Licensee conducted a full review of the annual control model portion of the inspection. There were no deficiencies or citations discovered at this time during the annual facility inspection.

Exit interview, report signed, and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2024
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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