405850480-2-27-2025-29-AS-GHTO-DEB2VH-20250227164357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405850480
Report Date: 02/27/2025
Date Signed: 02/27/2025 04:44:28 PM

Document Has Been Signed on 02/27/2025 04:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	OAKS AT PASO ROBLES, THE		FACILITY NUMBER:	405850480
ADMINISTRATOR/ DIRECTOR:	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
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Asministrator Carl Meyer		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

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At 9:00am on 02/27/2025, Licensing Program Analysts (LAP) Haner-Tomasko and Jeffries arrived unannounced at the facility to conduct the facility annual inspection and to deliver on 3 separate complaint findings. LPAs met with Administrator Carl Meyer and Director Maria Middleton(S1), announced who they are and the reason for the visit.

At 9:30am S1 and LPAs toured the inside and outside of the facility. The following was inspected and noted during the annual visit:
Physical Plant & Environment Safety: The facility is a 3-story building with 97 resident rooms total, 24 are memory care rooms. All rooms have an on-suite bathroom. The memory care unit has a courtyard area for residents to be outside, there are furnishing with umbrellas to protect residents, guest and staff from outside elements. Each floor has multiple community use restrooms, laundry rooms, snack bar and refreshment areas, and an assortment of recreation rooms such as painting room, workout equipment room, and television rooms. There are multiple offices, storage areas, and utility closets throughout the facility. The facility has four stairwells locations each have a fire evacuation chair located at the top of each stairwell. There are two elevators located in the central areas of the facility. The facility has a large reception area for guest and visitors. LPA noted that during the physical walking tour of the facility LPA was able to audit several resident rooms. LPA noted that all rooms were properly equipped by regulation standards. LPA noted that all appliances were in good working condition, the temperature of the facility was regulated between 70-75*(f), and that assisted grab bars were firmly secured on the walls.

Infection Control: The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, and hand soap. Staff are trained annually in infection control precautions. Facility has 30-day supply of PPE.

(Continued LIC809-C)

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

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: OAKS AT PASO ROBLES, THE	FACILITY NUMBER: 405850480
	VISIT DATE: 02/27/2025

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Personnel Records & Training: The facility keeps confidential files for each staff member. LPA reviewed a sample of staff training records. Staff handling medications had annual training of 8 hours of medication training.

Staffing: The facility employs approximately 43 staff and 1 Administrator. Staff records are kept confidential. LPA reviewed a sample number of files for current 1st Aid/CPR, Health screening with TB results, training and fingerprint clearance. Administrator has current certification.

Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. LPA reviewed a sample number of files for signed Admission Agreements, Medical Assessments, Pre-Admission appraisals, and Appraisal Needs and Services Plans.

Resident Rights Information: Personal rights, Rights to Resident Council, Theft and Loss policy, and Non-discrimination notice were publicly posted. CCL Complaint poster and LTCO poster were posted in multiple common areas of the facility. The current license along with PIN's were posted. Internet is provided in each resident room for confidentiality and privacy.

Planned Activities: The facility offers activities to all residents in care. Daily activities are displayed on television screens throughout the facility and provided in print each day. A lecture on heart health for residents was actively in session during the tour and the memory care unit was conducting a craft activity. The facility also offers additional activities that can be found in common areas throughout the facility to include books, magazines, newspapers, television, daily walks, group discussions and communications, games and puzzles. The facility has a piano for resident use. The facility has sufficient space to allow for indoor activities.

(Continued LIC809-C)

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: OAKS AT PASO ROBLES, THE	FACILITY NUMBER: 405850480
	VISIT DATE: 02/27/2025

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Food Service: The facility employs food service staff. The kitchen and dining room are located on the second floor (ground level from the east side main entrance). The memory care unit has a self-contained kitchenette. The facility handles and prepares food safely. The facility has 2 days perishables and 7 days non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. A menu is posted for residents in care. Modified diets prescribed by a physician are followed for those residents in care. Cleaning solutions and equipment are stored separately than food supply. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Kitchen staff are observed for personal hygiene and food sanitation practices.

Incidental Medical & Dental: During resident interviews it was found transportation to medical appointments is provided by the facility if needed and upon request.

Disaster Preparedness: The facility has four stairwells throughout the facility each has a fire evacuation chair located at the top of each stairwell. There are two elevators located in the central areas of the facility.

Residents with Special Health Needs: LPA observed doors of residents using oxygen have “Oxygen in Use” signs posted outside their room doors. Home health agencies come in to assist residents who need help with oxygen administration and staff are trained in accordance.

LPAs conducted interviews with 5 Residents and 4 Staff.

Exit interview conducted and copy of report printed for Administrator.

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

LIC809 (FAS) - (06/04)

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