405850480-8-27-2025-29-AS-KBUY-DL2KQX-20250830080704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850480
Report Date: 08/27/2025
Date Signed: 08/27/2025 03:55:38 PM

Unsubstantiated

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
04/03/2025 and conducted by Evaluator Garrett Haner-Tomasko

COMPLAINT CONTROL NUMBER: 29-AS-20250403134447

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: 85	DATE:	08/27/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator - Carl Meyer		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident sustained multiple pressure injuries while in care due to staff neglect
Resident sustained unexplained injuries while in care
Resident's toileting needs are not being met

INVESTIGATION FINDINGS:

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On 8/27/2025 at 10:30am Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to further investigate the allegations to this complaint. LPA met with Administrator Carl Meyer and explained the purpose of the visit.

During the visit LPA interviewed staff, administrator, and obtained relevant documents.

On the allegations: Resident sustained multiple pressure injuries while in care due to staff neglect and resident sustained unexplained injuries while in care. It was alleged Resident 1 (R1) had approximately 4 wounds or pressure injuries about the size of a quarter or half-dollar and what appeared to be bruising on their tailbone and back.

(Conitnued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250403134447

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: OAKS AT PASO ROBLES, THE	FACILITY NUMBER: 405850480
	VISIT DATE: 08/27/2025

NARRATIVE

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LPA interviews with resident’s primary care physician, hospice nurse, and resident’s family member revealed R1 was not diagnosed with pressure injuries at the time of this allegation and the unexplained injuries were likely bruises caused by previous falls R1 had sustained at the facility. Based on the information obtained, the allegations are deemed unsubstantiated at this time.

On the allegation: Resident's toileting needs are not being met. It was alleged that on 3/30/2025 and 3/31/2025 facility staff did not change R1 all day and in the evening both days Person 1 (P1) assisted R1 clean up and get ready for bed. Interviews revealed P1 was brought on service by R1’s family to provide R1 additional support. Interviews revealed R1 did have a rash where the briefs sit on the resident’s body that may have been caused by not being assisted with their continence needs timely. 6 of 6 staff interviews reveal R1 has occasional accidents, R1 often asks staff for assistance to the restroom, and staff are not aware of R1 having a rash due to not meeting R1’s continence needs. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies cited at this time.

Exit interview conducted, report signed, and report provided to the Administrator.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025

LIC9099 (FAS) - (06/04)

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