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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405801971
Report Date: 09/22/2025
Date Signed: 09/22/2025 10:21:21 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
09/18/2025 and conducted by Evaluator Garrett Haner-Tomasko
COMPLAINT CONTROL NUMBER: 29-AS-20250918113529
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: DATE:
09/22/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Licensee/Administrator - Eric BunteTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff are video-monitoring residents as a form of supervision
INVESTIGATION FINDINGS:
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At 9:05am, on 9/22/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to investigate the allegation of this complaint. LPA met with Licensee/Administrator Eric Bunte, announced who he was and the reason for the visit.

During the visit the LPA conducted interviews with residents, staff, and collected relevant documentation

On the allegation, staff are video-monitoring residents as a form of supervision. It was alleged that two of the four resident rooms had video cameras and staff stated they put them in the rooms to watch the residents not record them.

(Continued on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
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-20250918113529
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: 09/22/2025
NARRATIVE
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During today's visit LPA toured the facility to find no cameras in the residents rooms. LPA interview with Staff #1 (S1) revealed S1 installed cameras in resident bedrooms #2, 3, and 4 to watch the residents at night so they would not have to go in and disturb the resident to check on them. S1 removed them recently after a visit from the Long Term Care Ombudsman to the facility on 9/15/2025.

Interview with the Licensee/Administrator and facility record review reveal the facility does not have and has not applied for a waiver to install surveillance devices in resident rooms. Licensee also stated current residents have not given consent for the camera's in their rooms and residents have not requested the cameras be installed in their bedrooms.

Based on all interviews conducted and documents obtained, at this time the above allegation was found to be substantiated, based on the facility installing cameras in the residents bedroom to monitor them violating 4 of 5 resident's right to privacy.

Exit interview conducted, deficiencies cited on LIC9099-D page, report signed, and report provided to the Licensee/Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250918113529
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: 09/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2025
Section Cited
CCR
87468.2(a)(1)
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Amended. Personal Rights. (a)(1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the internet, and meetings of resident and family groups.
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S1 removed the cameras from the bedrooms after the LTCO visit on 9/15/2025. Licensee will review this regulation with all staff and email LPA documentation and signed training on or before 10/6/2025.
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This requirement was not met as evidenced by: Based on interview and record review, the licensee placed video cameras in 3 of 4 residents rooms without resident consent which poses a potential Personal Rights risk to persons in care.
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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: 10/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3