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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201257
Report Date: 04/16/2024
Date Signed: 04/16/2024 01:02:58 PM

Document Has Been Signed on 04/16/2024 01:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:GOOD SHEPHERD OF DANVILLEFACILITY NUMBER:
079201257
ADMINISTRATOR/
DIRECTOR:		CASTRO, ROCHEFACILITY TYPE:
740
ADDRESS:287 VERDE MESATELEPHONE:
(925) 719-9351
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: 6CENSUS: 6DATE:
04/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Administrator, Merdith CastroTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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On 4/16/2024 at 12:50PM Licensing Program Analyst (LPA) A Gomez conducted a case management as a result of information received during a complaint visit. LPA spoke with Administrator, Merdith Castro and informed them of the nature of the Case Management.

During interviews for a complaint received 4/11/2024 R1 stated that on 4/15/2024 there was not staff on schedule available to assist them with going to sleep from 9:00pm to 11:00pm. R1 stated that an off duty staff was at the facility cooking themself dinner and that when R1 asked for assistance the staff told them that they would need to wait for the next caregiver to be on duty.

LPA reviewed the staff schedule and spoke with S1 and S2 over the phone who both stated that there was no gap in the schedule. The facility does not have a sign in sheet for staff. Administrator also provided LPA with a copy of the staff schedule that showed full coverage for the night. LPA was unable to determine if there was a gap in coverage for 4/15/2024. LPA went over the importance of having staff readily available and discussed the facility possibly implementing a sign in and out sheet for staff on duty.


No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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