397005614-8-17-2022-27-AS-LKIG-CHNQ6H-20220826115331

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397005614
Report Date: 08/17/2022
Date Signed: 08/17/2022 06:48:31 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2022 and conducted by Evaluator Maja Jensen

COMPLAINT CONTROL NUMBER: 27-AS-20220628091012

FACILITY NAME:	SHEPHERD HOMES 1		FACILITY NUMBER:	397005614
ADMINISTRATOR:	ADELFA RUTH BANAGA		FACILITY TYPE:	740
ADDRESS:	5956 GLEN STREET		TELEPHONE:	(209) 478-2545
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	15	CENSUS:	DATE:	08/17/2022
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Edgar Espirtu		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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staff made in appropriate comments to resident
staff touched resident inappropriately

INVESTIGATION FINDINGS:

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On 8/17/22 Licensing Program Analyst Maja Jensen arrived at facility unannounced to deliver findings to the above listed allegations. Licensing Program Analyst Jensen met with Licensee Edgar Espiritu and explained the purpose of today's visit.

As to the allegation of staff made inappropriate comments to resident 1 (R1), the Department conducted several interviews during the course of the investigation. The Department also reviewed records including but not limited to the Licesing Information Sytem, staff roster, personnel reports, resident roster, resident file, and admission agreement. Staff and residents interviewed denied hearing any staff members make inappropriate comments. The preponderance of evidence standard has not been met, therefore the above allegation is determined to be UNSUBSTANTIATED. A finding that the allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

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

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20220628091012

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SHEPHERD HOMES 1	FACILITY NUMBER: 397005614
	VISIT DATE: 08/17/2022

NARRATIVE

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As to the allegation of staff touched R1 inappropriately, the Department conducted several interviews during the course of the investigation. The Department also reviewed records including but not limited to Licensing Information System, staff roster, personnel reports, resident roster for R1, preplacement appraisal, physician reports, medication lists and emergency contact information. Staff denied witnessing or hearing of any inappropriate action by other staff members. R1 indicated that their roommate witnessed the inappropriate touching. R1's roommate denied having witnessed anything inappropriate. The preponderance of evidence standard has not been met, therefore the above allegation is determined to be UNSUBSTANTIATED. A finding that the allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies are being cited. Exit interview was conducted and a copy of this report and appeal rights were emailed to Licensee.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC9099 (FAS) - (06/04)

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