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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 01:50:20 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
05/22/2024 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20240522102559
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 do not ensure that the facility is maintained sanitary.
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 allegations 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 do not ensure that the facility is maintained sanitary.” It was alleged that “the facility and residents' rooms smells like poop because of the residents urinating and defecating everywhere.” It was discovered through observation, interview and documentation that on 05/23/2024 in a facility physical inspection with Facility Administrator Carl Meyer and LPA Jeffries, observed R1’s room had an overwhelming smell of ammonia, and trace evidence if fecal matter on the floor. LPA noted that there was an attempt to clean the room however that the ammonia and urine smell was overwhelming to LPA that LPA had to leave the room at first approach to catch his breath. Administrator stated that he agreed that the smell was also overwhelming during that physical inspection of R1’s room. CONTINUED on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
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 6
Control Number 29-AS-20240522102559
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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 On 05/31/2024, LPA reviewed R1’s facility charting notes dated 05/24/2024, stating “ ***Late entry from 05/23/2024*** Resident apartment had strong ammonia like odor upon entrance. This may have been due to pervious alleged urination onto the PTAC unit in (R1’s) apartment. PTAC unit was removed, pressure washed, sanitized and then installed back in place. A urine odor removal spray was also applied. On May 24th the odor appears to have reduced. – Serviced on May 23, 2024 at 01:00PM”. At this time there in enough evidence to support the allegation of, “Staff do not ensure that the facility is maintained sanitary.” and is substantiated at this time.

Exit interview, report read, citation issued, report and appeal rights 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 6
Control Number 29-AS-20240522102559
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 B
03/11/2025
Section Cited
CCR
87265(b)(3)
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87625 Managed Incontinence (b)…Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.
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Administrator will email LPA (Garrett.Haner-Tomasko@dss.ca.gov) a copy of facilities emergency cleaning policy and statement of facility procedure to address emergency sanitation protocols no later than 03/07/2025.
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 This requirement was not met by evidence of “ammonia like smell” in R1’s room and poses a potential risk to residents 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: 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: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
05/22/2024 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20240522102559

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: 97DATE:
02/27/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Carl MeyerTIME COMPLETED:
03:33 PM
ALLEGATION(S):
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Staff do not ensure that residents' dietary needs are met.
Staff do not ensure that residents' incontinence needs are met.
Staff do not ensure that residents are provided with a safe environment.
Staff do not provide residents with activities.
INVESTIGATION FINDINGS:
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 As to the allegation of, “Staff do not ensure that residents’ dietary needs are met.” It was alleged that,
residents are not served adult size food portions, fresh fruit or fruit juice and that the only beverage served to residents is water, facility rarely served vegetables, residents are served either one piece of bacon or one sausage, one pancake and water, and residents do not like those foods. It was discovered through interviews, observations, and documentation, that on 05/23/2024, 06/10/2024, and 08/19/2024 LPA Jeffries conducted a tour of facilities Kitchen during breakfast and lunch time services. LPA noted that meals prepared matched facility menu schedule. On 06/10/2024, at 8:00am LPA ordered and partook of facility breakfast. LPA noted portions were normal and choice was provided. On 05/23/2024 and 06/10/2024 LPA Jeffries observed breakfast preparation and service of memory care unit and noted that proportions were normal, and choice was provided and also noted that eggs and fresh fruit was provided on both dates. On 05/23/2024, LPA Jeffries conducted interview with Staff 6 (S6) who stated, all food service is followed by facility menu schedule. All residents have the choice of items off menu schedule and facility option menus are on all dining table. CONTINUED on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20240522102559
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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 S6 also stated that there is no physician prescribed diets at this time. On 06/10/2024, LPA Jeffries conducted interviews with Residents 6, 7, 8, and 9 (R6, R7, R8 and R9) all stated that the food is of good quality, size and verity. On 05/23/2024, LPA Jeffries conducted interviews with S5 and S6 who both stated that the food the facility provided is of good quality, verity, and proportions. LPA reviewed facility weekly meal plans from April through May of 2024 that list a varied meal services with a verity of food choices. On 06/02024 LPA Jeffries reviewed facilities annual diet and culinary services audit with a 95.45% score. At this time there not enough evidence to support the allegation of, “Staff do not ensure that residents’ dietary needs are met.” and is unsubstantiated at this time.

As to the allegation of, “Staff do not ensure that residents’ incontinence needs are met.” It was alleged that, Resident 1 (R1) and R2 rooms “smelled like poop” because of the residents urinating and defecating everywhere. It was discovered through interviews, observation and documentation that on 05/23/2024 LPA Jeffries conducted interviews with Direct Care Staff 1 (S1) who stated, Both R1 and R2 have exhibited behaviors that involves handling their stools. S1 stated that both residents Physicians have been notified of the behaviors, all care staff have been addressing the behaviors as they happen, and house cleaning staff attend to the residents as needed. S1 also stated that they can call housekeeping at any time for emergency clean ups in memory care. On 05/23/2024, LPA Jeffries conducted an interview with Administrator Carl Meyer who stated that the housekeeping staff is available and will respond when called to do emergency clean ups in memory care unit as needed. On 06/10/2024 LPA conducted interviews with S2, S3, and S4 all who stated that Resident incontinence is always addressed when needed, basic clean up is done by care staff, and housekeeping is available for emergency clean up on request. On 05/23/2024, 06/10/2024, and 08/19/1014 LPA Jeffries observed sufficient direct care staffing in memory care unit. On 05/31/2024 LPA reviewed staff training records to be current and within regulation standards for direct care staff interviewed. At this time there is not enough evidence to support the allegation of, “Staff do not ensure that residents’ incontinence needs are met.” and is unsubstantiated at this time.

CONTINUED on LIC9099-C
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: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 29-AS-20240522102559
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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 As to the allegation of, “Staff do not ensure that residents are provide with a safe environment.” It was alleged that, R4 makes sexually inappropriate comments to residents and staff. It was discovered through documentation and interviews that on 05/23/2024 LPA Jeffries conducted an interview with S1 who stated that all memory care staff have been educated and trained on intervention techniques with R4’s behaviors. Staff have been instructed to redirect R4 when these behaviors are exhibited. On 05/31/2024 LPA reviewed staff training records to be current and within regulation standards for direct care staff interviewed. LPA reviewed R4’s facility care level service plan which indicated that R4 has a moderate assist for these behaviors. Additionally, there are facility notes addressing daily behaviors of R4 with a specific of date May 16th addressing the frequency of these behaviors. Additionally, there is a note on 05/23/2024 pertaining to medication changes and possible consideration for eviction due to not being able to meet increasing care needs if they persist. LPA noted that on 05/23/2024, 06/10/2024, and 08/19/1014 LPA Jeffries observed sufficient direct care staffing in memory care unit. At this time there in not enough evidence to support the allegation of, “Staff do not ensure that residents are provide with a safe environment.” and is unsubstantiated at this time.

As to the allegation of, “Staff do not provide residents with activities.” It was alleged that facility does not provide memory care with activities. It was discovered through interviews, documentation and observation that on 05/23/2024 LPA Jeffries interviewed S1 who stated that memory care has scheduled activities every per day. On 05/23/2024, 06/10/2024, and 08/19/1014 LPA Jeffries observed sufficient direct care staffing in memory care unit and activities for residents being conducted. LPA noted by observation that not all residents participated in the scheduled activities. On 06/10/2024, LPA Jeffries conducted interviews with S2, S3, and S4 who all stated that the facility provided daily activities for memory care residents. On 05/31/2024 LPA Jeffries observed facility activities schedule for memory care. At this time there in not enough evidence to support the allegation of, “Staff do not provide residents with activities.” and us unsubstantiated at this time.

Exit interview, report read, 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: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6