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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005616
Report Date: 09/28/2026
Date Signed: 09/28/2026 02:46:42 PM

Document Has Been Signed on 09/28/2026 02:46 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SHEPHERD HOMES 2FACILITY NUMBER:
397005616
ADMINISTRATOR/
DIRECTOR:		ADELFA RUTH BANAGAFACILITY TYPE:
740
ADDRESS:5964 GLEN STREETTELEPHONE:
(209) 478-2170
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 15CENSUS: 14DATE:
09/28/2026
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Ruth EspirituTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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A Non-Compliance Conference (NCC) was conducted today on September 28, 2026, via Microsoft Teams with the Sacramento South Regional Office. Present in the meeting were Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Liza King, and Licensing Program Analyst (LPA) Michael Bilger. Licensee and designees Ruth Espiritu and Edgar Espiritu were present during this meeting. The non-compliance conference process was explained during this meeting to include the administrative process.

On 7-29-2026, Licensee has received two A citations and one B citation. The regulated areas of which the citations occurred were Care and supervision and incidental medical care.

Citations issued by the Department include:

7-29-2026: Type A – Health and Safety Code (H&S Code) Section 1569.312(e) Basic Service Requirements. Licensee did not ensure adequate level of supervision for R1 resulting in a severe injury to R1.

[Cont. on 809C}

Liza King
Michael Bilger
DATE: 09/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SHEPHERD HOMES 2
FACILITY NUMBER: 397005616
VISIT DATE: 09/28/2026
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7-29-2026: Type A – Community Care Regulations (CCR) Section 87465(g) Incidental Medical and Dental Care. Licensee did not ensure the immediate call to 911 after learning of hot soup spilling onto R1’s thigh area.

7-29-2026: Type B – Health and Safety Code (H&S Code) Section 1569.312(a) Basic Service Requirements. Licensee did not ensure additional offerings of showers and shower assistance to R1 in relation to length of R1’s residency at facility.

Topics discussed during today’s Non-Compliance Conference were:

· Care and Supervision

· Client Records – proper maintenance of various documentation

· Administrator qualifications and duties

· Emergency protocols and when to call 9-1-1

· Food Service policies and procedures including proper temperature assessment

{Cont. on 809C}

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Michael Bilger
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2026
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SHEPHERD HOMES 2
FACILITY NUMBER: 397005616
VISIT DATE: 09/28/2026
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The Licensee has agreed to the following for purposes of reaching substantial compliance:

· Licensee and designee will ensure compliance plan is being followed

· Licensee will ensure Administrator is physically present at facility for a minimum of 40 hours per week

· Ensure all staff including Administrator and Licensee are in compliance with required training: Checking food temperature procedures prior to serving, observing and reporting changes in residents’ conditions including but not limited to burns and other incidents, proper documentation regarding delivery of care to residents, and emergency protocols/calling 9-1-1, Training to be conducted initially by 10-12-2026, then every six months thereafter, and evaluated by LPA during visits and inspections.

· Daily documentation of residents’ conditions including but not limited to: Participation in Activity of Daily Living (ADL) functioning, various changes in conditions including those warranting any 9-1-1 calls

· Maintenance of other documentation including but not limited to: Care notes, needs and services plans (updated yearly or sooner if significant changes occur), physician’s reports, medication log sheets, and incident reports

{Cont. on 809C}

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Michael Bilger
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2026
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SHEPHERD HOMES 2
FACILITY NUMBER: 397005616
VISIT DATE: 09/28/2026
NARRATIVE
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· Submit an updated LIC 500 to include Administrator days and hours scheduled. Submit by end of day 9-29-2026.

· Submit an updated LIC 308 by end of day 9-29-2026.

For best practices and consistency purposes in regards to maintaining compliance, the above implementations are to also be included at licensee’s additional facilities: Shepherd Homes 1 #397005614

In addition, at this meeting the notified Licensee/Administrator was advised future non-compliance regarding the above and other regulatory components will result in additional citations, civil penalties, and further potential administrative action.

Community Care Licensing Department (CCLD) will do the following:

· Quarterly visits to ensure above compliance plan and other Title 22 and Health and Safety code requirements.

· Refer licensee to technical support program (TSP) for compliance assistance

Completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager.



{Cont. on 809C}
NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Michael Bilger
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SHEPHERD HOMES 2
FACILITY NUMBER: 397005616
VISIT DATE: 09/28/2026
NARRATIVE
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Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited during this visit. An exit interview was conducted with Licensee and a copy of this report was provided via hard copy with signature on file to remain at Department.
NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Michael Bilger
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2026
LIC809 (FAS) - (06/04)
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