019200847-10-29-2025-15-AS-YFLS-DN5RSY-20251105121731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200847
Report Date: 10/29/2025
Date Signed: 10/29/2025 12:32:24 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/28/2025 and conducted by Evaluator Ardalan Gharachorloo

COMPLAINT CONTROL NUMBER: 15-AS-20250728162147

FACILITY NAME:	GOOD SHEPHERD OF DUBLIN, THE		FACILITY NUMBER:	019200847
ADMINISTRATOR:	CASTRO, MERDITH		FACILITY TYPE:	740
ADDRESS:	8206 RHODA AVE		TELEPHONE:	(925) 895-2569
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	6	CENSUS: 5	DATE:	10/29/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Brando Benedito, Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Satff did not treat resident with dignity
Staff did not provide a safe enviorment for resident in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/29/2025 at 9:50 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to deliver findings in regard to the allegations above. LPA met with Administrator, Brando Benedito and explained the purpose of the visit.

During the course of the investigation, LPA interviewed residents R1–R3, staff S1–S3, and witnesses W1,W2 and W3. LPA reviewed three resident files (R1–R3), including admission agreements, physician reports, MARs, and R1’s hospice file. Five staff files (S1–S5) and staff training logs were reviewed and found to be current. LPA toured resident rooms R1–R3 and obtained a copy of the LIC500 and staff schedule.

Allegation: Staff did not treat resident with dignity – Unsubstantiated

Staff interviews revealed consistent statements that residents are treated respectfully and care is provided only with consent. S1 stated, “If a resident refuses a bath or care, we respect their wishes and document it.”

***CONTINUE ON 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 15-AS-20250728162147

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: GOOD SHEPHERD OF DUBLIN, THE	FACILITY NUMBER: 019200847
	VISIT DATE: 10/29/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

***CONTINUE FROM 9099***

S2 stated, “We always ask permission before any personal care, and we never force anything.” LPA also interviewed S3 who shared, “We’re trained to maintain dignity and privacy in everything we do.” LPA interviewed 3 residents. All residents interviewed reported positive interactions with staff. W2, stated, “We both love this place; the staff are always kind and gentle with my mom.”

Record review confirmed that all staff had up-to-date training on resident rights, personal care, and abuse prevention. Based on interviews, file review, and observations, the allegation that staff did not treat the resident with dignity is unsubstantiated.

Allegation: Staff did not provide a safe environment for resident in care – Unsubstantiated

Staff consistently reported that the facility follows safety procedures and provides 24-hour supervision. S1 stated, “We do safety checks throughout the night and make sure each resident is secure and comfortable.” S2 added, “We never use chairs or objects to block residents in; that’s not allowed here.” S3 further stated, “If a resident has mobility issues, we contact hospice or use proper equipment — never makeshift barriers.”

LPA’s room tours revealed no safety hazards, and all resident areas were properly maintained. Staff training records verified that all employees had completed current training in emergency procedures, and supervision. During LPA's interview with R1 and R2 ,both residents stated that staff frequently come into the room and check in. R1 and R2 did not express any concerns regarding safety in the facility.

This agency investigated the allegations above. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted. A copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2