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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455000113
Report Date: 10/13/2023
Date Signed: 10/13/2023 01:33:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/29/2023 and conducted by Evaluator Ivan Avila
COMPLAINT CONTROL NUMBER: 59-AS-20230929113310
FACILITY NAME:SHEPARD COURTFACILITY NUMBER:
455000113
ADMINISTRATOR:CARLEY, LANAFACILITY TYPE:
735
ADDRESS:1000 SHEPARD COURTTELEPHONE:
(530) 222-0765
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:6CENSUS: 2DATE:
10/13/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lana CarleyTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff left clients unattended
Staff sleeping during their shift
Facility is in disrepair
Administrator did not follow proper administrator recertification requirements
Staff drinks alcohol during their shift
INVESTIGATION FINDINGS:
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On 10/13/2023 Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegations directed by the Department. LPA Avila met with Lana Carley and explained the purpose of visit.

On 10/04/2023 Licensing Program Analysts (LPAs) Ivan Avila and Jaynae Boyles arrived at the facility at 9:30 AM. LPAs knocked at the front door. Client opened the door and LPAs asked where the Licensee was; the client stated Licensee was sleeping. The client went back into the house and knocked on the Licensee’s door (staff room) and told her LPAs were there. Licensee was the only staff working at the time LPAs arrived at the facility. LPAs observed clients were left unattended while Licensee was sleeping during their shift. One deficiency will be cited as LPA substantiated the same regulation violation.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
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 7
Control Number 59-AS-20230929113310
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SHEPARD COURT
FACILITY NUMBER: 455000113
VISIT DATE: 10/13/2023
NARRATIVE
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On 10/04/2023 LPA Avila noticed there were cracked ceilings in the facility and broken tile in one of the bathrooms that lead into the shower. LPA Avila also reviewed an inspection report conducted by Far Northern Regional Center on 10/02/2023 that also notated the cracked ceilings in the living room, kitchen, and broken tile in the bathroom.

On October 11, 2023, an in-person informal meeting was held in the Chico Regional office. Present in the meeting was Licensing Program Manager (LPM) Lauren Crocker, Licensing Program Analyst (LPA) Ivan Avila and Licensee/Administrator, Lana Carley.

During the informal meeting Licensee stated she paid for the recertification of Administrator classes but has not started any of the required training. Licensee’s Administrator certificate is currently expired and will attend the required training and hire an interim Administrator to run the facility.

Licensee admitted during the informal meeting that in the past she has made staff alcoholic drinks during their shifts once to twice a month.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, and the California Health and Safety Code are being cited on the attached LIC9099-D.

An exit interview was conducted, and a copy of report and appeal rights were provided.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 59-AS-20230929113310
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SHEPARD COURT
FACILITY NUMBER: 455000113
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/20/2023
Section Cited
HSC
1548(c)(3)
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1548(c) The department shall assess an immediate civil penalty of five hundred dollars...(3) Absence of supervision, as required by statute or regulation. The requirement is not met as evidence by:
Based on observation, the licensee did not comply with the section cited above
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Licensee agreed to purchase a call button system for all resident rooms and willl maintain that the call buttons are operational at all times. Licensee will install and send proof to CCLD by 10/20/2023.

Immediate $500 penalty assesed.
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as resident stated Licensee was sleeping and resident knocked on the door to wake Licensee resulting in the absence of supervision, which possesses an immediate Health, Safety, and Personal Rights risk to persons in care.
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Type A
10/20/2023
Section Cited
CCR
80065(g)
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80065(g) All personnel, including the licensee, administrator and volunteers, shall be in good health, and shall be physically, mentally, and occupationally capable of performing assigned tasks. This requirement is not met as evidence by:
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Licensee agrees to hold in-service training with all staff to review the facility's drug and alcohol policy. Submit sign-in sheet and written confirmation of training completion to CCLD by 10/20/2023 date to clear the deficiency.
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Based on interviews, the licensee did not comply with the section cited above as Licensee stated she has provided alcohol to staff while on shift in the past, which poses an immediate Health, Safety, and Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 59-AS-20230929113310
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SHEPARD COURT
FACILITY NUMBER: 455000113
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
85064(b)
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85064(b) All adult residential facilities shall have a certified administrator. This requirement is not met as evidence by:
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The Administrator agrees to submit proof of hiring a temporary Administrator to run the facility until Administrator receives the updated Administrator Certificate. Administrator will submit proof of the temporary Administrator to CCLD by 10/27/2023
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Based on interviews and record review, the licensee did not comply with the section cited above as one out of one has expired Administrator Certification, which poses a potential Health, Safety, and Personal Rights risk to persons in care.
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Type B
10/27/2023
Section Cited
CCR
80087(a)
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80087(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidence by:
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Licensee shall ensure facility is maintained in good repair at all times. Licensee has put out an ad for a handyman and has held interviews and will replace the broken tile and fix the ceilings in the facility. Licensee will submit proof of fixed tile and ceiling to CCLD by 10/27/2023.
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Based on observation, the licensee did not comply with the section cited above as there are cracks in the living room and kitchen cielings. Broken tile from bathroom step leading into the shower, which poses a potential Health, Safety, and Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7