SHEPHERD HOMES 2

Official classification

Type A

Official code

1569.312(e)

Regulation authority

HSC

What the official deficiency says

1569.312 Basic Service Requirements. (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This requirement was not met as evidenced by: Based on interviews and record reviews, Licensee did not ensure adequate level of supervision for R1 resulting in a severe injury to R1. This posed an immediate health and safety risk to resident in care.

Official plan of correction

Licensee to ensure completed staff training on proper supervision of residents in care. Training date to be submitted to LPA by POC due date. Proof of completed training to be sent to LPA no later than 8/14/2026. Licensee to develop and submit a protocol outlining proper supervision procedures of residents. Protocol to include various examples of scenarios which constitute certain levels of supervision. Protocol to be submitted to LPA by POC due date.

Deadline recorded: Jul 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health…This requirement was not met as evidenced by: Based on interviews and record reviews, Licensee did not ensure the immediate call to 911 after learning of hot soup spilling onto R1’s thigh area. This posed an immediate health and safety risk to resident in care.

Official plan of correction

Licensee will ensure completed staff training on Section 87465(g). Training to include proper response to emergencies and when to call 911. Training date to be submitted to LPA by POC due date. Proof of completed training to be submitted to LPA no later than 8/14/2026. Licensee to develop and submit a protocol outlining procedures of when to call 911. Protocol to include various examples of scenarios which constitute a call to 911 Protocol to be sent to LPA by POC due date.

Deadline recorded: Jul 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.312(a)

Regulation authority

HSC

What the official deficiency says

1569.312 Basic Service Requirements. (a) Care and supervision as defined in Section 1569.2. This requirement was not met as evidence by: Based on record reviews and interviews, Licensee did not ensure additional offerings of showers and shower assistance to R1 in relation to length of R1’s residency at facility. This posed a potential health, safety, and resident rights risk to residents in care.

Official plan of correction

Licensee to develop and submit a plan outlining how staff will consistently meet and/or attempt to meet residents’ showering needs and other assistance with activities of daily living needs. Plan to be submitted to LPA by POC due date. Licensee will read Section 1569.2 and submit a written declaration of understanding of the definition of “care and supervision” to LPA by POC due date.

Deadline recorded: Aug 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

Basic Services Basic services shall at a minimum include:... Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing...This requirement was not met as evidenced by: Based on interviews conducted with staff and residents, on 2 separate occasions residents required critical assistance and there was no staff in the dining room. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to submit an attestation by email, by POC due date, to maja.jensen@dss.ca.gov stating that all meal services will be conducted with supervision by staff.

Deadline recorded: Sep 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements The following food service requirements shall apply:... Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met as evidenced by: Based on LPA's observation of expired food, and unsafe food storage practices during teh course of 2 site visits. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to conduct a deep cleaning of the kitchen and add procedures to kitchen staff duties that include monthly self audits for expired food. The Licensee will email the new procedures and photos of kitchen post cleaning to maja.jensen@dss.ca.gov by POC due date.

Deadline recorded: Sep 26, 2023. 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

80087(a)(1)

Regulation authority

CCR

What the official deficiency says

80087 Buildings and Grounds ... (1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement was not met as evidenced by: Based on LPA's observation of active insects in front hall, the bathroom located closest to the front entrance and kitchen. This poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

The Licensee agrees to install magnetic screens to doors that do not currently have netting or screens and the Licensee will enter in to a pest control service agreement with interior and exterior service to be provided monthy. Licensee will email a dated and signed pest control contract that includes a service address. Licensee will also email photos of the magnetic screens to CCLD at maja.jensen@dss.ca.gov

Deadline recorded: Sep 28, 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

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 observation and interview, the licensee did not comply with the section cited above in that LPA observed food sitting on the floor in kitchen and food debris in refrigerator not clean. LPA observed paint and items not in use or good repair stored in backyard which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/24/2021 Plan of Correction The licensee agrees to provide proof of items removed, repaired, or cleaned to LPA by POC due 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 last inspected on 2/4/2020, last sticker placed in 11/2019 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.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. 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 medications not administered per physician's orders in that Resident one (R1) PRN for administration 3 times daily did not match medications count, 2 pills missing from start date beginning quantity of 42 and PRN log not documented administrations 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 medication audit and schedule an in service scheduled to LPA by POC due date. Proof of completion due upon scheduled date.