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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850480
Report Date: 08/26/2026
Date Signed: 08/26/2026 03:47:03 PM

Document Has Been Signed on 08/26/2026 03:47 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, THEFACILITY NUMBER:
405850480
ADMINISTRATOR/
DIRECTOR:		ROBIN MURRAYFACILITY TYPE:
740
ADDRESS:526 S RIVER ROADTELEPHONE:
(805) 239-5851
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 120CENSUS: 82DATE:
08/26/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Administrator - Robin MurrayTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 8/26/2026 at 2:00pm, Licensing Program Analyst (LPA) Haner-Tomasko conducted an unannounced Case Management - Incident visit to the facility. LPA arrived at the facility, met with Administrator Robin Murray, and announced the purpose of the visit.

Community Care Licensing (CCL) recently received two separate incidents self-reported by the facility regarding medication errors. During today’s visit LPA conducted interviews and collected additional documents.

On 8/4/2026, CCL received a report from the facility stating that on 7/30/2026 Resident #1 (R1) was mistakenly given the medication carbidopa levodopa 25mg/100mg by facility staff. According to the report staff immediately notified R1’s primary care physician and responsible person after realizing the error. Interviews and record review revealed R1 is not prescribed the medication and was given the medication due too staff error. The medication-technician who made the error was counseled and assigned additional online self-paced medication training that was due on 8/9/2026 and as of today’s visit records reveal the training has not been completed.

On 8/19/2026, CCL received a report from the facility stating that on 8/7/2026 Resident #2 (R2) did not receive their anticoagulant medication, Coumadin 1mg, for six (6) days. According to the report, the error was discovered when R2’s family contacted R2’s primary care physician inquiring how R2 was doing. R2’s primary care physician contacted the facility at which point the facility discovered R2’s Coumadin order had been discontinued in the facilities electronic medication administration record (eMAR) on 7/30/2026.
(Continued on LIC809-C)
Kelly Burley
Garrett Haner-Tomasko
DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 08/26/2026
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Review of an order received by the facility from R2’s primary care physician on 7/30/2026 at 3:28pm states to discontinue R2’s Coumadin 1mg tablet current dose, hold the Coumadin for two (2) days, and new dose begins 8/1/2026 of Coumadin 1mg tablet on Mondays, Tuesdays, Wednesdays, Thursdays, Saturdays and Sundays and on Fridays two (2) tablets. Interview and record review reveal R2 received a dose of Coumadin 1mg on 7/29/2026 and did not receive the medication again until 8/7/2026, when the error was discovered and R2 was given two (2) tablets because 8/7/2026 was a Friday. Due to staff error R2 did not receive Coumadin on 7/30/2026 and 7/31/2026 unintentionally following the physician order to hold the medication for two days. Meaning R2 did not receive their Coumadin from 8/1/2026 – 8/6/2026, or six (6) days. Interviews also revealed the error occurred when facility staff received the new order on 7/30/2026 and manually discontinued the previous order in the eMAR. Staff state that the pharmacy typically electronically enters new orders into the eMAR system for the facility and this did not happen. Staff state as a backup the facility will typically create a paper MAR to document new orders until the pharmacy enters the order electronically. Interviews and record review reveal a paper MAR was not created by staff until 8/7/2026 when the error was discovered.

Although review of both incidents indicate that different staff were involved in each medication error and the facility self-reported the errors to CCL, it is important to note that the facility was previously cited during inspections conducted in February 2025, March 2025, and December 2025 for similar medication documentation and administration errors, demonstrating an ongoing pattern of noncompliance.

Exit interview conducted, deficiency cited on LIC809-D page, report signed, appeal rights and report provided to the Administrator.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Garrett Haner-Tomasko
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/26/2026 03:47 PM - It Cannot Be Edited


Created By: Garrett Haner-Tomasko On 08/26/2026 at 03:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 08/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2026
Section Cited
CCR
87465(a)(4)

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 (a)A plan for incidental medical and dental care shall be developed by each facility... (4)The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:
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Administrator states they will submit a plan to the LPA by 8/27/2026 detailing formal counseling plans for staff who made the error and ensure staff training is completed by 9/9/2026. They will email the completed training certificates to LPA on or before 9/9/2026.
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Based on record review and interview, the licensee did not comply with the section cited above when staff provided R1 a medication they were not prescribed and did not provide R2 their medication as prescribed, which posed an immediate health and safety 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.
Kelly Burley
NAME OF LICENSING PROGRAM MANAGER:
Garrett Haner-Tomasko
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2026


LIC809 (FAS) - (06/04)
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