079201559-6-12-2026-15-AS-GLUK-DY32S2-20260918173826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201559
Report Date: 06/12/2026
Date Signed: 06/12/2026 01:24:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2026 and conducted by Evaluator Yasamin Brown

COMPLAINT CONTROL NUMBER: 15-AS-20260605161459

FACILITY NAME:	GOOD SHEPHERD OF PITTSBURG		FACILITY NUMBER:	079201559
ADMINISTRATOR:	CASTRO, ROCHE		FACILITY TYPE:	740
ADDRESS:	2297 JACQUELINE DRIVE		TELEPHONE:	(925) 635-3474
CITY:	PITTSBURG	STATE: CA	ZIP CODE:	94565
CAPACITY:	6	CENSUS: 5	DATE:	06/12/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Adelina Danieles, Care Staff		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff speak inappropriately to residents
Facility staff does not ensure residents dressed appropriately

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 6/12/2026 at 10:00 am, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Adelina Danieles, Care Staff and informed the reason for visit.

During investigation, LPA reviewed the Resident Roster and Staff Schedule. LPA obtained the following documents for residents (R1, R2, R3 and R4): LIC602 (Physicians report) and LIC625 (Appraisal Needs and Services Plan). LPA conducted interviews with R1, R2, R3, R4 and Staff (S1, S2 and S3).

Administrator gave authorization for Adelina to sign today's report.

Continue on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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 2

Control Number 15-AS-20260605161459

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: GOOD SHEPHERD OF PITTSBURG	FACILITY NUMBER: 079201559
	VISIT DATE: 06/12/2026

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

Continued from LIC9099.

Allegation: Facility staff speak inappropriately to residents

Finding: Unsubstantiated

It was alleged that facility staff speak inappropriately to residents. Interview with W1 revealed that they have witnessed an individual that swears at a vehicle in the facility driveway but they are unsure if it is a resident or a staff. During staff and resident interviews, it was revealed to the LPA that the individual that swears at the vehicle in the facility driveway is R1 and the vehicle belongs to R1. W1 stated that R1 does not swear at the neighbors or any residents but at the vehicle. Interview with residents revealed that have never experienced any staff speaking to them in an inappropriate manner. Residents interviewed did not report instances of verbal mistreatment, and no witnesses or documentation corroborated the allegation. Staff demonstrated appropriate and respectful communication with residents during LPA observations.

Allegation: Facility staff does not ensure residents dressed appropriately

Finding: Unsubstantiated

It was alleged that Facility staff does not ensure residents dressed appropriately. Interview with W1 revealed that they have witnessed R1's pants sagging due to working on their vehicle in the facility driveway. LPA observed during record review that R1's LIC602 dated on 09/09/2025, stated that R1 is able to dress/groom self. Interview with staff revealed that R1 is able to dress themselves and chooses what they want to wear. Interview with R2 and R3 revealed that they are able to dress themselves and they pick out their own clothes. R4 stated that the staff assist them with changing their clothes but R4 stated that they pick out their own clothing. Interview with staff revealed that they do not dress residents inappropriately and they allow them to pick out the clothes they want to wear.

Based on interviews, record review and observations conducted, the above allegations are unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No deficiency cited. Exit Interview conducted with Adelina and copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2