SHEPHERD HOMES 1

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

(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.

Official 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.

Deadline recorded: Dec 14, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, the licensee did not comply with the section cited above in LPA observed trash, unused bikes, vehicles, and children’s toys around the sides and backyard area of the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/07/2022 Plan of Correction Administrator will clean the backyard area and sides of the facility and send proof to LPA by 10/07/2022 POC date.

Official classification

Type B

Official code

87555(9)

Regulation authority

CCR

What the official deficiency says

General Food Requirements:(9)Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation the facility refrigerator has several containers without dates or labels which poses a potential health, safety risk to residents in care.

Official plan of correction

POC Due Date: 10/07/2022 Plan of Correction Administrator will clean the facility fridge and send proof to LPA by 10/07/2022 POC date.

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in that 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 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2021 Plan of Correction The licensee agrees to submit planned date of medication audit and staff in service scheduled to LPA by POC due date. Proof of completion due upon scheduled date.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and records review, the licensee did not comply with the section cited above that fire suppression system was last inspected in 3/2020 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2021 Plan of Correction The licensee agrees to submit planned date of inspection scheduled to LPA by POC due date. Proof of completion due upon scheduled date.