Shepherd's Inn

Type of visit: POC

On August 26, 2026 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a visit to clear open Plan of Corrections (POC). LPA introduced themselves and was allowed entrance into the facility. LPA met with Administrator Lita Williams. During todays visit LPA cleared the following POCs: 97309(a)(1)- Windex was removed from bathroom 87303(a)- Refrigerators were cleaned/wiped down 87303(e)(5(A)- Non-slip mats were replaced. Exit interview was conducted and a copy of this report LIC809 and cleared POC letters were provided to Administrator Lita Williams.the state’s words, verbatim · CDSS document, Aug 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) B. Miranda conducted an unannounced visit today for the facility’s annual inspection. LPA introduced themselves and was allowed entrance into the facility. LPA met with Lita Williams. Facility is licensed for 6 residents and has a current census of 5. There are no residents on hospice and none with home health. Water temperature was checked in the kitchen which read at 105.4 degrees Fahrenheit and the common bathroom which read at 105.8 degrees Fahrenheit. Smoke and carbon monoxide detectors were tested and in working order. Lita Williams Administrator's Certification expires September 16, 2027. Staff and resident files were reviewed. First aid kit on site and will be replenished by August 5, 2026. There is a locked storage for medications. Sample of resident medication was reviewed and no issued were found. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms, bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean, properly furnished, with adequate lighting, and in good repair. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed Windex Window Cleaner in a common bathroom accessible to residents in care. LPA observed refrigerators needing to be cleaned from spillage & garage pantry outlet covered needing to be replaced. LPA observed a non-slip mat to have rubber/latex stripped in bathroom closest to front door. LPA observing expired food in jars and discolored pasta in jars in garage pantry. Administrator stated new furnace will be installed by August 1, 2026. Administrator stated when the cameras are placed up the additional lock from front door will be removed. Administrator stated the lock was put on due to knocking on the door in the middle of the night. Deficiencies observed were cited during today's inspection per California Code of Regulations, Title 22. LPA is requesting 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 and a copy of this report LIC809, LIC809D, and appeal rights were provided to Lita Williams.the state’s words, verbatim · CDSS document, Jul 29, 2026

Type of visit: Required - 1 Year

On 07/23/2025, Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility unannounced to conduct a required Annual Inspection visit. LPA introduced herself, stated purpose of visit, and was allowed entrance by staff. Administrator Lita Williams was contacted, and arrived shortly after. LPA toured the facility inside and out including entry, kitchen, dining, living room, bedrooms, bathrooms, and exterior. LPA observed facility to have a sprinkler system, Administrator stated it has checked by the fire department, but they do not have any documentation. Medications are stored in a locked cabinet in the dining room. Knives and sharp objects are secured in the kitchen. LPA observed chemicals to be locked up in the garage and under the kitchen sink. There is an upstairs to the home, which is only used for the Administrator and her sister, who is also training to be an Administrator for this home. Facility has 9 bedrooms, 6 of which are for residents. There are 4 bathrooms, 2 which are for residents. Residents do not share bedrooms. Last fire drill was recorded as being held on 05/14/2025. Fire extinguishers show charged and were last serviced 7/24/24. There are smoke alarms in the facility that were tested and working properly. Administrator was unable to provide proof at this time the sprinkler system is in working condition. Carbon monoxide detector was tested and found to not be in working condition. Water temperature was checked in hall bathroom and the kitchen sink and read at 139.6 degree Fahrenheit, water heater was immediately lowered at tank by Licensee. LPA did observe some of the following deficiencies: medication not being properly recorded on centrally stored log, audio alarms not on in one bedroom, clients do not have updated medical assessments, CPR certificates are expired. (continued on next page) Exit interview was conducted and a copy of this report LIC809 was provided to Administrator Lita Williams. A copy of the current Insurance to be provided to LPA Boyd at CCL by 08/01/2025the state’s words, verbatim · CDSS document, Jul 23, 2025

Type of visit: POC

On 9/24/2024 Licensing Program Analysts (LPAs) B. Miranda & R. Bruce arrived at the facility unannounced to check on the POCs. LPAs introduced themselves and explained the reason for the visit. LPAs met with Licensee Lita Williams. LPAs observed the following and cleared POCs: On 7/27/2024 Licensee bought smoke detectors and installed them at the facility, POC cleared Garage was cleaned and reorganized, POC cleared Cleaning solutions and locked under the sink, POC cleared Food storage area in the garage has been cleaned, POC cleared Kitchen area in the garage has been cleaned and reorganized, POC cleared Food containers in garage have been replaced, POC cleared Centrally Stored Medication Log has been corrected and updated, POC cleared Staff are cleared and allowed to return to the facility, POC cleared POCs were cleared, printed, and provided to the Licensee. Exit interview was conducted and a copy of this report LIC809 was provided to Licensee.the state’s words, verbatim · CDSS document, Sep 24, 2024

Type of visit: Case Management - Annual Continuation

On 7/27/24 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to complete the annual inspection. LPA met with Licensee Lita Williams. On 7/9/24 LPA observed the following deficiencies: Smoke detectors were not present in the home, Administrator was not able to provide verification the sprinkler system is in working condition. Gardening tools were in an unlocked drawer in kitchen which are accessible to residents in care. Toxins and cleaning supplies were stored in a cabinet under the sink and in a cabinet next to the sink which was unlocked. The garage also has cleaning supplies which was not locked. Canned food and additional refrigerators are stored in the garage area which is not clean and has rodent droppings throughout the garage. Garage is used to store food which is not being maintained. Garage area used for additional kitchen is not being maintained. Food is not being stored or labeled properly. Medications are not being logged on the centrally stored medication log. There are no audio alarms on the exits and dementia residents reside in the facility. Staff use R1's room to go outside to throw the trash. Staff member S1 was at the facility without being properly associated to the facility. LPA observed staff at the facility. Staff member S2 was on the staff schedule and was working NOC shift according to Licensee. Licensee will provide insurance verification by 8/6/24. Citations were issued per Title 22. Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Administrator Lita Williams.the state’s words, verbatim · CDSS document, Jul 27, 2024

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 7/9/24, Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a required Annual Inspection visit. LPA introduced herself, stated purpose of visit, and was allowed entrance by staff. Administrator Lita Williams was contacted, and arrived shortly after. LPA toured the facility inside and out including entry, kitchen, dining, living room, bedrooms, bathrooms, and exterior. LPA observed facility to have a sprinkler system, but Administrator stated it has not been serviced for a few years. Medications are stored in a locked cabinet in the kitchen. Knives and sharp objects are secured in the kitchen. LPA observed tools to be in unlocked drawer in the kitchen. LPA observed some unlocked toxins under the sink and in a cabinet next to the sink. Facility has 9 bedrooms, 6 of which are for residents. There are 4 bathrooms, 2 which are for residents. Residents not share bedrooms. Fire extinguishers show charged but were last serviced 7/27/22. There are currently no smoke alarms in the facility. Administrator was unable to provide proof at this time the sprinkler system is in working condition. Carbon monoxide detector was tested and in working condition. Water temperature was checked in one resident's bathroom and read at 119.8 degree Fahrenheit. LPA did observe some of the following deficiencies: food being stored and not properly labeled/dated, non-perishable items being kept in the garage with pest issue (droppings), medication not being properly recorded on centrally stored log, audio alarms not on, resident's room being used to access outside while throwing trash. LPA will return at a later date to complete annual inspection and issue citations. Exit interview was conducted and a copy of this report LIC809 was provided to Administrator Lita Williams.the state’s words, verbatim · CDSS document, Jul 9, 2024