<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606836
Report Date: 11/04/2025
Date Signed: 11/04/2025 12:53:40 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/29/2025 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251029124547
FACILITY NAME:GOOD SHEPHERD HOMEFACILITY NUMBER:
197606836
ADMINISTRATOR:FEDELITO RUIZFACILITY TYPE:
740
ADDRESS:14812 LA FONDA DRIVETELEPHONE:
(714) 739-1182
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:6CENSUS: 5DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Fedelito Ruiz TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff serve residents expired food.
Facility staff did not ensure that expired food was discarded.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the allegations listed above. The purpose of the visit was explained to Licensee Fedelito Ruiz.

The investigation consisted of: A physical plant tour of the home was conducted. A total of 4 staff were interviewed. Only 1 resident was interviewed. All other resident have limited verbal/cognitive ability and/or are non-verbal. Resident files were reviewed. Copies of resident modified diet physician orders, face sheets, staff roster, and resident roster were obtained.

*Note: During physical plant observations, split bed rails and three-quarter length bed rails were observced. A case management report was generated to issue a citation for postural supports.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
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 3
Control Number 28-AS-20251029124547
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: GOOD SHEPHERD HOME
FACILITY NUMBER: 197606836
VISIT DATE: 11/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Facility staff serve residents expired food. It is alleged that on On September 29, 2025, a Regional Center Quality Assurance and Compliance Specialist conducted an unannounced visit and found expired produce [lettuce & strawberries], container lid with mold, and food containers with mold in the kitchen refrigerator. A total of 4 staff were interviewed. All staff acknowledged the allegation. Staff interviews revealed that one week before the facility had a large family celebration, and staff put left over food in the main refrigerator but did not throw out old food that had mold and was wilted beyond safe consumption. Staff stated that they have never served residents any expired food. One resident was interviewed, they stated the food served is good. They did not have any food complaints. During today's visit, 3 refrigerators were observed in the facility. All refrigerators had food that is safe for consumption and labeled. Licensee stated that a plan of action was put in place the day after Regional Center observations, and all inedible food was discarded right away. Based on record review, a Corrective Action Plan was issued on October 28, 2025. LPA obtained picture evidence of expired food. Therefore, there is sufficient evidence to support the allegation.

Allegation: Facility staff did not ensure that expired food was discarded. The complaint alleges the 7-day non-perishable food pantry had 15 items that were expired. The expiration date of the 8 canned food and 5 bags of instant potatoes ranged from 11/2024 to 9/28/2025. All staff acknowledged the allegation and stated that expired food items were an oversight, and moving forward they have put in place staff protocols that ensures canned food expiration dates are marked and checked prior to use. The resident that was interviewed had no knowledge of the allegation. LPA observed the food pantry now has two separate storage spaces, one of residents and the other for staff use. No expired food pantry items were observed today. Resident file review indicates 4 residents have physician orders for modified food diets. Based on record review, the Regional Center issued a Corrective Action Plan dated October 28, 2025 and a Semi-Annual Residential Review that states deficiencies were observed during the visit that resulted in substantial inadequacies. Therefore, there is sufficient evidence to support the allegation.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are cited according to California Code of Regulations, Title 22. See LIC 9099D.

An exit interview was conducted with Administrator Fedelito Ruiz. A copy of the report and appeal rights was issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20251029124547
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GOOD SHEPHERD HOME
FACILITY NUMBER: 197606836
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/11/2025
Section Cited
CCR
87555(b)(28)
1
2
3
4
5
6
7
General Food Service Requirements. The following food service requirements shall apply: All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement was not met evidenced by:
1
2
3
4
5
6
7
Licensee stated the expired food was immediately removed and a plan of action was put in place the following day (9/30/25).

1. Administrator agreed to submit proof of staff training.
2. Plan of Action and logs were provided today.
8
9
10
11
12
13
14
On 9/29/25, Regional Center specialist observed wilted lettuce, strawberries with mold, and food containers with mold in the kitchen refrigerator. This poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Licensee shall inspect all food storage areas and discard all expired cans. Licensee shall submit a written statement, that all expired cans were discarded and will monitor food supply frequently. Submit self-certification by POC due date.
Type B
11/11/2025
Section Cited
CCR
87555(a)
1
2
3
4
5
6
7
General Food Service Requirements. The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.
1
2
3
4
5
6
7
Licensee shall ensure staff inspect all food storage areas and discard all expired cans. Licensee provided a copy of the plan of action put in place 9/30/25, food supply will be checked weekly and staff will sign a log.

1. Submit proof of staff training.
8
9
10
11
12
13
14
On 9/29/25, Regional Center specialist observed that 7-day non-perishable food pantry had 15 items that were expired.
This poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
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: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3