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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850480
Report Date: 02/27/2025
Date Signed: 02/27/2025 02:29:00 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/22/2025 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20250122091828
FACILITY NAME:OAKS AT PASO ROBLES, THEFACILITY NUMBER:
405850480
ADMINISTRATOR:CARL MEYERFACILITY TYPE:
740
ADDRESS:526 S RIVER ROADTELEPHONE:
(805) 239-5851
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:120CENSUS: 82DATE:
02/27/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Carl MeyerTIME COMPLETED:
03:33 PM
ALLEGATION(S):
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Staff did not administer residents’ medication.
INVESTIGATION FINDINGS:
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 At 9:00am on 02/27/2025, Licensing Program Analyst (LPA) Jeffries and Haner-Tomasko arrived to the facility unannounced to issue final findings on the allegation to this complaint. LPA's met with Administrator Carl Meyer, announced who they are and the reason for the visit. LPA's also conducted facility annual for 2025 and issued final findings on two other different complaints on this visit.

As to the allegation of, “Staff did not administer residents’ medication.” It was alleged that Resident 1 (R1) was paying for medication management that was not being conducted correctly during the time period of July 2023 through October of 2024 (approximately 398 days). It was discovered through interviews, observations, medication audit, and physical medication count; that on 01/22/2025, Licensing Program Analyst Jeffries (LPA) conducted a phone interview with Family Member 1 (F1). F1 stated that the facility had returned 5 different types of medication to F1 after R1 was no longer a resident of the facility in October of 2024. On 01/30/2025, LPA Jeffries conducted an interview with facilities Memory Care Director, Staff 1 (S1).
CONTINUED on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2025
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-20250122091828
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OAKS AT PASO ROBLES, THE
FACILITY NUMBER: 405850480
VISIT DATE: 02/27/2025
NARRATIVE
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S1 stated that the prior Resident Service Director had shredded R1’s Centrally Stored Medication Records (CSMR) and could not produce those records as requested by LPA Jeffries. S1 did have Medication Administration Records (MAR) for R1 and were reviewed by S1, Facility Administrator, Carl Meyer, and LPA that shows which medications were administered as prescribed. On 01/30/2025, Facility Administrator and LPA conducted a documented medication audit comparing Medication Prescriptions, Medication Invoices, MAR dates and times and the physical medications that were returned to F1 upon R1’s exit of the facility. That Medication and Document audit showed that for medication 1(Md1) there were 450 total pills sent to the facility, and 18 were returned to F1 indicating that there were approximately 30 pills over the number of MARs indicated. For medication 2 (Md2), there were 450 pills provide to the facility with 106 pills returned to F1, indicating 344 MAR as indicated which is approximately 54 pills of medication there were not administered despite MAR indicating those pills were administered to R1 on facility MAR. There were 540 pills of medication 3 (Md3) that were provided to the facility, and 176 were returned to F1, indicating 346 MARs indicated, which is approximately 56 pills that were not administered when MAR indicated they were administered to R1. There were 540 pills of medication 4 (Md4) provided to the facility, and 245 were returned to F1 indicating there were approximately 103 pills that were not administered to R1. There were 450 pills of medication 5 (Md5) that were sent to the facility, and 365 pills returned to F1, which is approximately 83 pills that were not administered to R1. LPA noted that on 01/29/2025 and 01/31/2025 physical medication counts were conducted with no discrepancy in count of the numbers of pills returned to F1, before and prior to the full medication audit to ensure accuracy. At this time there is enough evidence to support the allegation of, “Staff did not administer residents’ medication.” and is substantiated at this time.

Exit interview, report read, citation issued, appeal rights and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250122091828
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: OAKS AT PASO ROBLES, THE
FACILITY NUMBER: 405850480
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/13/2025
Section Cited
CCR
87465(a)(1)
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87465 Incidental Medical and Dental Care (a)A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care ... (1)The licensee shall arrange, or assist in arranging,
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The Administrator shall conduct a comprehensive medication audit, with all residents in care to ensure that medications are in sync with Physicians orders, CSMR, MAR and physical medication count with a summary plan for audit submitted to LPAs emails by 02/28/2025. And audit completed
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 for medical and dental care appropriate to the conditions and needs of residents. The requirement was not met by evidence of R1 missing hundreds of medication passes which puts the Resident in immanent danger.
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with in two weeks on or before 03/14/2025. And submit proof of audit in CSMR, MAR, Physician Prescription Order and physical medication count to LPA by email on or before 03/14/2025.
Type A
02/28/2025
Section Cited
CCR
87465(a)(6)
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(a)A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (6)When requested by the prescribing physician or the Department,
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The Administrator shall have all staff who distribute medications and staff that manage the staff who distribute medication completed a comprehensive medication training of no less than 2 hours by a authorized vender of Department of Social Serviced, State of California.
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 a record of dosages of medications which are centrally stored shall be maintained by the facility. By evidence of S1 stating that R1's Centraly Stored Medication Records (CSMR) had been shreeded, which poses in immanent danger to Resident in care.
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Administrator will provided LPA by email a list of employees who will take that class and the vender and class subject title by email on 02/28/2025 and will have all staff completed the training by 03/14/2025. And submit proof of training to LPA by email on or before 03/14/2025.
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: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3