405850480-2-27-2025-29-AS-KBUY-DEBTD2-20250228133738

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850480
Report Date: 02/27/2025
Date Signed: 02/27/2025 03:18:09 PM

Unsubstantiated

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
08/15/2024 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20240815101438

FACILITY NAME:	OAKS AT PASO ROBLES, THE		FACILITY NUMBER:	405850480
ADMINISTRATOR:	CARL MEYER		FACILITY TYPE:	740
ADDRESS:	526 S RIVER ROAD		TELEPHONE:	(805) 239-5851
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	120	CENSUS: 82	DATE:	02/27/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator, Carl Meyer		TIME COMPLETED:	03:33 PM

ALLEGATION(S):

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Facility staff did not dispense medications according to physician's orders.
Facility staff did not ensure residents had drinking water.
Facility staff did not meet resident's incontinence care needs.

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, “Facility staff did not dispense medications according to physician's orders.” It was alleged that on 08/08/2024 and 08/09/2024 that Staff 6 (S6) administered the residents' 4pm medications and 6pm medications at the same time and not according to physicians’ orders in memory care unit. It was discovered through interviews and documentation that on 08/19/2024, LPA Jeffries attempted to interview residents 1-5 (R1, R2, R2, R4, and R5), basic screening question did result in cognitive normal answers or silence. On 08/19/2024, LPA Jeffries conducted an interview with S1 who stated that there was no resident who had medications that were prescribed for both 4pm and 6pm.
CONTINUED on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

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-20240815101438

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 08/19/2024, LPA Jeffries reviewed staff scheduled that shows staff alleged distributing medications as not prescribed per physician’s orders was not scheduled at the facility on the days of the allegations. On 08/16/2024, 08/19/2024, 02/19/2025 and 02/02/23/2025 LPA made attempts to contact Reporting Party with contact information left, for clarification on allegations, however no contact was unable to be established on all attempts and no call back contact from Reporting Party. On 08/20/2024, LPA reviewed medication administration training for all MedTech’s scheduled in the month of August 2024 to be up to date per Community Care Licensing Regulations. On 08/19/2024 and 02/21/2024, LPA reviewed facility internal documentation medication pass for alleged event and noted that the staff alleged of not dispensing medications according to physicians’ orders was assigned to any med passes on 08/08/2024 and 08/09/2024 additionally was not working according to staff scheduling as noted above. At this time there is not enough evidence to support the allegation of, “Facility staff did not dispense medications according to physicians’ orders.” and is unsubstantiated at this time.

As to the allegation of, “Facility staff did not ensure residents had drinking water.” It was alleged that residents in memory care were not provide water when dispensing medications, looked dehydrated, and hadn't had any water to drink for several hours. It was discovered through observations, photographs, and interviews that, on 08/19/2024, LPA Jeffries conducted a physical tour of the facility focusing on the memory care unit. LPA observed 3 pitchers of water, all more than 50% full, two pitchers of water in the common area and one pitcher of water in the dining area on a cart all accompanied with paper cups. LPA Jeffries took photographs of the three water stations. LPA also noted that at least 4 of the 8 residents sitting at the common area table during activity time had cups of water. On 08/19/2024, LPA Jeffries attempted to interview residents R1, R2, R2, R4, and R5, screening question did result in cognitive normal answers or silence. On 08/19/2024, LPA Jeffries conducted an interview with Direct Care Staff 1 (S1) who stated that they bring water with them when dispensing medications, as well as the water stations placed throughout the memory care unit. At this time there is not enough evidence to support the allegation of, “Facility staff did not ensure residents had drinking water.” 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: 02/27/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240815101438

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, “Facility staff did not meet resident's incontinence care needs. It was alleged that resident sat in their room in urine and feces unattended by care staff. It was discovered in a prior investigation that R6 had behaviors related to incontinence. 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.

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: 02/27/2025

LIC9099 (FAS) - (06/04)

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