Shepherd Homes 1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual visit on this date. LPA met with Edgar Espiritu and explained the purpose of the visit. LPA inspected physical plant including but not limited to kitchen, bedrooms, bathrooms, living and dining room area. LPA observed the facility. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 119 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present LPA observed centrally stored medications. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed resident and staff files, including criminal record clearances. All staff today are associated to the facility. First aid kit was checked and is complete. Per California Code of Regulations, Title 22 Division 6, Chapter 8, No deficiencies were observed during this visit. Exit interview held and a report given at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 17, 2023

Allegation investigated: Staff did not supervise resident adequately resulting in resident wandering from the facility.

On 12/7/22 at XXXX Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegation. On 12/2/22 LPA Jensen interviewed staff 1 (S1) and staff 2 (S2). S1 confirmed that on the date in question, at approximately 4pm, staff reported resident 1 (R1) missing from the facility. Law enforcement and the responsible party for R1 were notified. Social media posts were also made seeking assistance in finding R1. LPA Jensen was advised by both staff members that resident 1 often left the facility grounds but never went far from the facility and always came back. S2 also confirmed during the course of the interview that on the date in question, resident 1 went outside the facility in to the front yard unsupervised at approximately 3:30pm. Continued on LIC 9099C.... Substantiated LPA Jensen also reviewed R1's file and determined that an LIC 624 that was completed for R1 on 2/22/22.The LIC 624 states that R1 cannot leave the facility unsupervised. LPA Jensen reviewed the Admission Agreement for R1. The Admission Agreement states under section 2A that the facility agrees to provide "continuous observation, care and supervision". Based on interviews conducted and records reviewed the allegation of staff did not supervise resident adequately resulting in resident wandering from the facility is SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met. Deficiencies are being cited from the California Code of Regulations (CCR), Title 22, Division 6. Failure to correct deficiencies may result in civil penalties. An exit interview was conducted and a copy of this report and appeal rights were given to the Licensee.the state’s words, verbatim · CDSS document, Dec 7, 2022 · control 27-AS-20221130130943

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Dec 14, 2022

(a) ...residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: ... (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on interviews conducted and records reviewed the licensee did not adequately supervise R1 resulting in R1 wandering from the facility. This poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 7, 2022

Plan of correction: The licensee agrees to cease accepting residents with a diagnosis of dementia and will submit an addendum to the plan of operation for review by Community Care Licensing should they choose to provide dementia care in the future. The Licensee will email confirmation of this plan to LPA Jensen at maja.jensen@dss.ca.gov by the plan of correction due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Edgar Espiritu Continual Administrator's Certification expires 03/20/2023. There are currently 15 residents who reside at this home and there is 1 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 110 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. The Licensee does not have staff COVID 19 vaccine cards or exemptions on file for all facility staff. LPA observed the outside of the facility to have old bikes, children's toys, and trash around the sides of the facility, and backyard area. LPA observed the facility refrigerator to have several containers with food inside not labeled or dated. The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Administrator, Edgar Espiritu and copy of report left at facilitythe state’s words, verbatim · CDSS document, Sep 24, 2022

Allegation investigated: staff made in appropriate comments to resident staff touched resident inappropriately

On 8/17/22 Licensing Program Analyst Maja Jensen arrived at facility unannounced to deliver findings to the above listed allegations. Licensing Program Analyst Jensen met with Licensee Edgar Espiritu and explained the purpose of today's visit. As to the allegation of staff made inappropriate comments to resident 1 (R1), the Department conducted several interviews during the course of the investigation. The Department also reviewed records including but not limited to the Licesing Information Sytem, staff roster, personnel reports, resident roster, resident file, and admission agreement. Staff and residents interviewed denied hearing any staff members make inappropriate comments. The preponderance of evidence standard has not been met, therefore the above allegation is determined to be UNSUBSTANTIATED. A finding that the allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Continued on LIC 9099C... Unsubstantiated As to the allegation of staff touched R1 inappropriately, the Department conducted several interviews during the course of the investigation. The Department also reviewed records including but not limited to Licensing Information System, staff roster, personnel reports, resident roster for R1, preplacement appraisal, physician reports, medication lists and emergency contact information. Staff denied witnessing or hearing of any inappropriate action by other staff members. R1 indicated that their roommate witnessed the inappropriate touching. R1's roommate denied having witnessed anything inappropriate. The preponderance of evidence standard has not been met, therefore the above allegation is determined to be UNSUBSTANTIATED. A finding that the allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies are being cited. Exit interview was conducted and a copy of this report and appeal rights were emailed to Licensee.the state’s words, verbatim · CDSS document, Aug 17, 2022 · control 27-AS-20220628091012

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a case management visit for health and safety checks. LPA met with caregiver Helen Artes and explained the purpose of today's visit. LPA Jensen toured the facility including common areas, resident bedrooms, grounds and kitchen. The facility had the thermostat set at 76 degrees which falls within the required regulatory range. The facility was observed to have in excess of 2 days of perishable food and 7 days of non-perishable food. LPA Jensen interacted with 15 of 15 residents. All residents indicated they were well and are treated well. LPA Jensen returned 3 resident files that were retrieved during the course of a site visit on 6/28/22. No deficiencies from the California Code of Regulations, Title 22 or the Health and Safety code were cited as a result of today's visit. An exit interview was conducted and a copy of this report was handed to care provider Helen Artes.the state’s words, verbatim · CDSS document, Jul 8, 2022

Type of visit: Required - 1 Year

On 10/27/2021 Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a Required 1-year Annual Inspection at 4:15pm with Licensee Edgar Espiritu. Administrator Ruth Banaga arrived shortly after. LPA was allowed entry into the facility that is licensed to serve a total capacity of 15 and today's census is 15. Licensee accompanied LPA on facility tour. Five of five staff observed on site with criminal record clearance in Licensing Information System. LPA observed Administrator Certificate expires on 8/29/2022 and Licensee's Certificate expires on 3/20/2023. LPA interacted with a random number of residents during this visit and observed clients. The physical plant was toured inside and outside to ensure the safety of the clients. LPA observed kitchen, restrooms, bedrooms, and common living areas. LPA observed items not in use or good repair stored in backyard. LPA observed toxins, knives, centrally store medications stored inaccessible to residents. The temperature inside the facility was measured at 74*F which is within the required range of 68*F and 85*F, or in areas of extreme heat the maximum shall be 30*F less than the outside temperature. The hot water was measured at 107*F within regulatory range of is not less than 105*F and not more than 120*F. The first aid kit was found in compliance containing at least the following: a current edition of an approved first aid manual, but containing sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and antiseptic solution. LPA observed COVID precautions signs posted, restrooms stocked with paper towels, hand soap, touchless covered trash cans, and posted hand washing signs. 30 day supply of PPE stored on site. Stsff one (S1) stated common surfaces are disinfected daily and in between use. LPA observed hand sanitizer available throughout the facility. Observed MAR system in use but weekends in October not signed by facility staff, not documented when staff two (S2) was scheduled off. S2 stated medications are given but not signed off on MAR because other staff administer them but they do not write it down. LPA observed fire extinguisher last inspected on 7/19/2021, fire suppression system last inspected on 3/2020. Observed smoke and carbon monoxide detectors, central heating and air in the facility. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. The facility last conducted fire drill on 6/20/2021. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Administrative Responsibility LIC308 Personnel Report LIC500 Administrator Certificate Emergency Disaster Plan LIC610E Liability Insurance Health Screening Report-Facility Personnel LIC503 First Aid/ CPR certificates Per California Code of Regulations (CCRs) - Title 22, Division 6, the following deficiencies are being cited on the attached 809D during this visit. Civil penalties shall be assessed when the licensee fails to correct the violation and any appropriate extensions to the plan of correction due date. The Licensee was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. Exit interview held and a copy of report was given.the state’s words, verbatim · CDSS document, Oct 27, 2021

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.