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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423935
Report Date: 12/23/2024
Date Signed: 12/23/2024 04:35:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2024 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20240909094435
FACILITY NAME:GOOD SHEPHERD MANOR, LLCFACILITY NUMBER:
366423935
ADMINISTRATOR:MARCHARELLI, IRENE CAPILIFACILITY TYPE:
735
ADDRESS:302 NORDINA ST.TELEPHONE:
(909) 798-2876
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:41CENSUS: 40DATE:
12/23/2024
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Administrator Irene MarcharelliTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff is retaliating against a client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bernadette Allen met with Administrator Irene Marcharelli at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office on 12/23/2024 at 4:15 PM to deliver the findings of the above allegation. LPA Allen explained the purpose of the requested office visit.

The investigation consisted of interviews with staff, and residents.

LPA interviewed staff members, asking if they had ever experienced or heard of any staff retaliating against the residents in care. Staff stated they have not been told or heard of any staff mistreating residents in care. The residents were asked if any staff member had retaliated against them or any other resident, and they also stated no one had treated them disrespectfully or retaliated against anyone to their knowledge. LPA was unable to interview Resident 1 (R1) because they have not been at the facility since August 29, 2019, and the Administrator Irene is unaware of their current location.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
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 56-AS-20240909094435
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: GOOD SHEPHERD MANOR, LLC
FACILITY NUMBER: 366423935
VISIT DATE: 12/23/2024
NARRATIVE
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Based on the interviews conducted with the staff and residents at the facility, the above allegation is found to be unsubstantiated. This means that while the allegation may have happened or is valid, there is not enough evidence to prove whether the alleged violations did or did not occur.

An exit interview was conducted where this report was discussed and provided to Irene Marcharelli at the conclusion of the visit with appeal rights.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2