366423935-1-15-2025-56-AS-BALN-DCXUKK-20250115143918

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366423935
Report Date: 01/15/2025
Date Signed: 01/15/2025 02:39:26 PM

Document Has Been Signed on 01/15/2025 02:39 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME:	GOOD SHEPHERD MANOR, LLC		FACILITY NUMBER:	366423935
ADMINISTRATOR/ DIRECTOR:	MARCHARELLI, IRENE CAPILI		FACILITY TYPE:	735
ADDRESS:	302 NORDINA ST.		TELEPHONE:	(909) 798-2876
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92373
CAPACITY: 41		CENSUS: 40	DATE:	01/15/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:20 PM
MET WITH:	Irene Capili, Administrator		TIME VISIT/ INSPECTION COMPLETED:	02:50 PM

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Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Irene Capili, Administrator, and discussed the purpose of the visit.

The facility is an Adult Residential Facility (ARF), license capacity of (41) with a current census of (40).

LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

Physical Plant: Indoor and outdoor passageways are free of obstruction. The facility has no bodies of water accessible to clients in care. The facility is maintained at a comfortable temperature between 70-75 degrees and the clients bathrooms were inspected at random with the water temperature measuring between 105 to 108 degrees F. The bathrooms upstairs and downstairs appeared to be working properly.

There was sufficient lighting and furniture in good repair throughout the facility. Facility has operating carbon monoxide alarms and telephone service. The facility has sufficient linen, towels, and personal hygiene items for clients. The facility has posted in a common area, Community Care Licensing complaint poster, facility license, disaster evacuation plan and emergency telephone numbers.

Food Service: Facility has sufficient non-perishable and perishable food supply for clients in care. Pesticides and other cleaning solutions were kept locked and stored away from food areas.

Care & Supervision: Facility has 24-hour, 7 days a week care staff. Staff working have criminal record clearances or exemptions through the Department.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/15/2025

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Record Review: Staff files were reviewed and appeared complete and up to date. The clients files reviewed appeared to be current and complete.

Medical Related Services: All medication is centrally stored and kept locked in the medication room and the MARS reviewed appeared to be dispensed as prescribed by their physician.

Based on LPA observations, no deficiencies were cited per Title 22, Division 6 of The California Code of Regulations.

An exit interview was conducted where reports LIC809, LIC809-C, was discussed and copies with Appeal Rights were provided to the Irene Capili- Administrator at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025

LIC809 (FAS) - (06/04)

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