Good Shepherd of Pittsburg

Allegation investigated: Facility staff speak inappropriately to residents Facility staff does not ensure residents dressed appropriately

On 6/12/2026 at 10:00 am, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Adelina Danieles, Care Staff and informed the reason for visit. During investigation, LPA reviewed the Resident Roster and Staff Schedule. LPA obtained the following documents for residents (R1, R2, R3 and R4): LIC602 (Physicians report) and LIC625 (Appraisal Needs and Services Plan). LPA conducted interviews with R1, R2, R3, R4 and Staff (S1, S2 and S3). Administrator gave authorization for Adelina to sign today's report. Continue on LIC9099-C. Unsubstantiated Continued from LIC9099. Allegation: Facility staff speak inappropriately to residents Finding: Unsubstantiated It was alleged that facility staff speak inappropriately to residents. Interview with W1 revealed that they have witnessed an individual that swears at a vehicle in the facility driveway but they are unsure if it is a resident or a staff. During staff and resident interviews, it was revealed to the LPA that the individual that swears at the vehicle in the facility driveway is R1 and the vehicle belongs to R1. W1 stated that R1 does not swear at the neighbors or any residents but at the vehicle. Interview with residents revealed that have never experienced any staff speaking to them in an inappropriate manner. Residents interviewed did not report instances of verbal mistreatment, and no witnesses or documentation corroborated the allegation. Staff demonstrated appropriate and respectful communication with residents during LPA observations. Allegation: Facility staff does not ensure residents dressed appropriately Finding: Unsubstantiated It was alleged that Facility staff does not ensure residents dressed appropriately. Interview with W1 revealed that they have witnessed R1's pants sagging due to working on their vehicle in the facility driveway. LPA observed during record review that R1's LIC602 dated on 09/09/2025, stated that R1 is able to dress/groom self. Interview with staff revealed that R1 is able to dress themselves and chooses what they want to wear. Interview with R2 and R3 revealed that they are able to dress themselves and they pick out their own clothes. R4 stated that the staff assist them with changing their clothes but R4 stated that they pick out their own clothing. Interview with staff revealed that they do not dress residents inappropriately and they allow them to pick out the clothes they want to wear. Based on interviews, record review and observations conducted, the above allegations are unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. No deficiency cited. Exit Interview conducted with Adelina and copy of this report provided.the state’s words, verbatim · CDSS document, Jun 12, 2026 · control 15-AS-20260605161459

Type of visit: Prelicensing

On 5/12/2026 at 2:00pm, Licensing Program Analyst (LPA) L. Hall conducted an announced pre-licensing inspection (CHOW) and met with Roche Castro Administrator, Facility's fire clearance is for five (5) non-ambulatory and one (1) bedridden resident. LPA toured the residents' rooms, shared bathrooms, dining rooms, common living areas, kitchen, and garage. There is sufficient lighting around the facility. Resident rooms are equipped with the proper furniture and lighting. The kitchen was observed cleaned and within compliance. Bathrooms were equipped with grab bars. Living room is equipped with the proper furniture for the residents. LPA observed toxins and sharps locked in cabinets. Passageways and hallways are free of obstruction. Fire extinguisher last purchased 4/21/2026. Smoke detectors and Carbon Monoxide detector are equipped around the facility. First aid kits are complete. LPA measured hot water in shared bathroom on 1st floor at 100.4. This is an existing facility and 2-day perishable, and 7-day non-perishable are available for the residents. Facility inspection matches the sketch that was provided. Continued on LIC809C. Continued from LIC809. LPA reviewed four (4) staff and all five (5) resident files all observed to be complete. There were not any issues during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 12, 2026

Type of visit: Case Management - Other

On 05/12/2026 at 4:00PM, Licensing Program Analyst (LPA) L. Hall arrived to conduct an announced to conduct a COMP III visit. LPA met with Roche Castro, Administrator, and explained the purpose of the visit. LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participant gained knowledge about running and maintaining the facility in accordance with regulations. A license has not yet been granted to this facility. Licensure is subject to final review and approval by the Centralized Applications Unit. Licensee is not to accept consumers until notified by Community Care Licensing that the license has been approved. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 12, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 06 Census : 06 Method: Telephone call with CAB COMP II Participants: CASTRO, ROCHE Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee's understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 6, 2026