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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455000113
Report Date: 01/23/2024
Date Signed: 01/23/2024 12:16:52 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: 1DATE:
01/23/2024
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Lana CarleyTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Clients are not provided proper food service
Clients are denied access to facility common areas
Staff do not treat clients with dignity and respect
Client was not properly allowed to exercise their right to vote
Clients do not have access to facility telephone
INVESTIGATION FINDINGS:
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On 01/23/2024 Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegations directed by the Department. LPA met with Lana Carley and explained the purpose of the visit.

During the investigation process, interviews and a records review were initiated.
LPA investigated the allegation, “Clients are not provided proper food service.” On 10/02/2023 a residential unannounced visit was conducted by Far Northern Regional Center. LPA Avila reviewed the documented visit and observed that the report stated the facility refrigerator had a lock and clients did not have access to food. Interviews conducted by LPA Avila also stated that food was locked, and clients are not provided snacks during the day.

Contined on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
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 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: 01/23/2024
NARRATIVE
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LPA investigated the allegation, “Clients are denied access to facility common areas.” Based on interviews conducted clients are denied access to the kitchen area, as it is dangerous when staff are preparing food. Clients are not allowed in the kitchen area, which also denies them access to food and snacks. Interviews also stated that when clients are provided with meals the dining table is not available for them to use and are sent to their rooms to eat their meals.

LPA investigated the allegation, “Staff do not treat clients with dignity and respect.” Based on interviews conducted, clients have been yelled at and cussed at by staff telling them to go back into their rooms after an argument. Clients have heard staff use profanity and yell at other staff when clients are present.

LPA investigated the allegation, “Client was not properly allowed to exercise their right to vote.” Based on interviews conducted C1 did not have a choice on casting their own vote and was told to copy a staff members ballot. The client was told who to vote for.

LPA investigated the allegation, “Clients do not have access to facility telephone.” Based on interviews clients do not have access to the facility phone. The facility phone is locked in a staff room making the facility phone inaccessible to clients in care.

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 cited on the attached LIC9099-D.

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

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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: 1DATE:
01/23/2024
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Lana CarleyTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Clients sustained unexplained injuries
Staff did not seek timely medical help for client in care
Staff do not follow proper reporting requirements
Staff mismanaged clients' funds
Staff did not safeguard client's personal belongings
Clients have access to knives
Staff did not ensure facility is free of pests
Staff did not ensure facility is free of mold
INVESTIGATION FINDINGS:
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On 01/23/2024 Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegations directed by the Department. LPA met with Lana Carley and explained the purpose of the visit.

During the investigation process, interviews and a records review were initiated.
LPA investigation the allegation, “Clients sustained unexplained injuries.” Based on interviews conducted clients stated that have not experienced any unexplained injuries. Clients stated they have had bruises before, but it had been caused by bumping into doorways. Staff interviewed stated they did not notice any unusual injuries to the clients.

Continued on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 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
VISIT DATE: 01/23/2024
NARRATIVE
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LPA investigated the allegation, “Staff did not seek timely medical help for client in care.” Based on interviews conducted, clients stated that when they get hurt or injured, they would be taken to the doctor. Staff have also scheduled a dentist’s appointment for clients but due to scheduling conflicts with the clinic’s appointment system they are backlogged.

LPA investigated the allegation, “Staff do not follow proper reporting requirements.” Based on observations and records reviews, the facility has submitted incident reports to the Department in a timely manner and has followed appropriate procedures.

LPA investigated the allegations, “Staff mismanaged client’s funds. Staff did not safeguard client’s personal belongings.” Based on interviews conducted, clients stated that they can buy anything they want. Everything they buy is placed in their room and can access their personal belongings.

LPA investigated the allegation, “Clients have access to knives.” Based on interviews conducted, clients and staff have stated that before COVID-19, clients were allowed to prepare their food with staff supervision. This allowed them access to all cutlery items with proper supervision. No client has dementia or imposes a health and safety risk.

LPA investigated the allegations, “Staff did not ensure the facility is free of pests. Staff did not ensure facility is free of mold.” Based on observations, LPA observed the common areas, kitchen, client bedrooms, bathrooms, and staff room and did not see any pests or mold in the facility. The facility had broken tile and cracks in the ceiling that were addressed in a previous report.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of the report was provided.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 4 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: 01/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2024
Section Cited
CCR
80076(a)(4)
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80076(a)(4) In facilities providing meals to clients, the following shall apply: (4) Between meal nourishment or snacks shall be available for all clients unless limited by dietary restrictions prescribed by a physician. This requirement is not met as evidence by:
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Facility will complete a statement of understanding regarding regulation 80076(a)(4). Facility will submit statement of understanding to LPA by POC due date of 02/06/2024
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Based on interviews and record review, the licensee did not comply with the section cited above as clients are not provided with snacks during the day and the refrigerator had a lock and clients are not allowed in the kitchen.
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Type B
02/06/2024
Section Cited
CCR
85087.3(a)
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85087.3(a) As a condition of licensure, there shall be common rooms... facilitate the program of planned activities specified in Section 85079, and to prevent such activities from interfering with other functions. This requirement is not met as evidence by:
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Facility will complete a statement of understanding regarding regulation 85087.3(a). Facility will submit statement of understanding to LPA by POC due date of 02/06/2024
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Based on interviews, the licensee did not comply with the section cited above as clients are eating their meals in their rooms and the dining table is not available for the clients. Clients are not allowed in the kitchen to access food.
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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: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 5 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: 01/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2024
Section Cited
CCR
80072(a)(1)
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80072(a)(1) each client shall have personal rights which include, but are not limited to ...To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as evidence by:
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Facility will complete a statement of understanding regarding regulation 80072(a)(1). Facility will submit statement of understanding to LPA by POC due date of 02/06/2024
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Based on interviews, the licensee did not comply with the section cited above as staff has yelled and used profanity towards clients.
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Type B
02/06/2024
Section Cited
CCR
85072(b)(11)
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85072(b)(11)The licensee shall insure that each client is accorded the following personal rights...To receive assistance in exercising the right to vote. This requirement is not met as evidence by:
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Facility will complete a statement of understanding regarding regulation 85072(b)(11). Facility will submit statement of understanding to LPA by POC due date of 02/06/2024
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Based on interviews, the licensee did not comply with the section cited above as client copied a staff members ballot and did not let client cast own vote.
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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: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 6 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: 01/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2024
Section Cited
CCR
85072(b)(9)
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85072(b)(9) To have access to telephones in order to make and receive confidential calls...do not restrict availability of the telephone during emergencies. This requirement is not met as evidence by:
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Facility will complete a statement of understanding regarding regulation 85072(b)(9). Facility will submit statement of understanding to LPA by POC due date of 02/06/2024
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Based on interviews, the licensee did not comply with the section cited above as the facility phone is locked in a staff room inaccessible to clients 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: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7