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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405801971
Report Date: 08/07/2025
Date Signed: 08/07/2025 11:11:06 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
08/04/2025 and conducted by Evaluator Garrett Haner-Tomasko
COMPLAINT CONTROL NUMBER: 29-AS-20250804132130
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: 5DATE:
08/07/2025
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Licensee/Administrator - Eric BunteTIME COMPLETED:
11:30 PM
ALLEGATION(S):
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Staff did not properly safeguard the residents medications
Staff allowed the residents access to a harmful material while in care
INVESTIGATION FINDINGS:
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At 09:10am on 8/7/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the initial investigation to the above allegations of this complaint. LPA met with Licensee/Administrator Eric Bunte, LPA announced who he was and the reason for the visit.

During LPA visit from 09:10am to 10:00am, LPA interviewed staff and Licensee and obtained copies of documents.

On the allegations: Staff did not properly safeguard the residents medications and staff allowed the residents access to a harmful material while in care. It was alleged by a reliable source, Person #1 (P1), that during a visit to the facility on the morning of 8/4/2025 P1 observed the pad lock on the door of the closet containing resident medications left unlocked and there was a gallon of bleach in the hallway on top of the washing machine. These items were accessible to the residents and this facility is licensed for dementia care.
(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 29-AS-20250804132130
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PASO ROBLES SENIOR LIVING
FACILITY NUMBER: 405801971
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2025
Section Cited
CCR
87309(a)
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(a)... the licensee shall ensure that disinfectants, cleaning solutions,... and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by:
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Licensee will perform a disciplinary write-up with S1 and S2 and email this to LPA by 8/8/2025. Additionally Licensee will have them individually write a statement of understanding of this regulation, how it can affect the residents in care and ways to prevent it in the future. Licensee will email
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Based on interview, the licensee did not comply with the section cited above when S1 left a bottle of bleach unattended and S1 and S2 left the medication closet unlocked leaving these items accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.
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these statements to the LPA on or before 8/14/2025.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250804132130
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PASO ROBLES SENIOR LIVING
FACILITY NUMBER: 405801971
VISIT DATE: 08/07/2025
NARRATIVE
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LPA toured the facility upon arrival to find no chemicals on the washer and dryer, the garage door, cabinets under the kitchen sink and bathrooms containing hazardous materials all locked. LPA noted the pad lock in an unlocked position hanging from the hasp latch lock on the medication closet. Staff were close by the medication closet and stated they were actively assisting residents with medications.

During LPA interview with Staff #1 (S1) and Staff #2 (S2), S1 admitted on the morning when P1 visited they left a half gallon of bleach on top of the washer or dryer and left it unattended within reach of residents in care while they cared for a resident in the bedroom closest to the front door of the facility. S2 stated they were in the kitchen not within sight of the bottle of bleach. S1 showed LPA the bottle of bleach that was left out, LPA photographed the bottle and noted it to be more than half full. Staff interview also revealed the pad lock on the hatch latch of the medication closet was left unlocked and unattended the same morning. Based on all interviews conducted, at this time the above allegations were found to be substantiated, there is a preponderance of the evidence to prove that the alleged violation occurred.

During LPA visit on 7/16/2025 to the facility for an annual inspection LPA cited on Title 22 regulation 87309(a). The Licensee/Administrator submitted their plan of correction for this citation on 7/28/2025 which included staff training on keeping medications and disinfectants locked and inaccessible to residents.

As this is a repeat violation of the same regulation within 12 months a civil penalty in the amount of $250 for a repeat violation is being assessed on the attached LIC 421FC.

Exit interview, deficiencies cited on 9099-D, report signed, report, LIC421FC and appeal rights given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
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