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ICF/DD-N (Nursing)License activeMedi-Cal certified

SHEPHERD DIVISION

ICF/DD-N (Nursing) · 6 licensed beds · Upland, CA

Homes of 4–15 beds for medically fragile people with developmental disabilities who need intermittent skilled nursing.

Address

SHEPHERD DIVISION862 W 23RD STUpland, CA 91784 · San Bernardino County

Phone: (909) 920-5954

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-N (Nursing)
Licensed beds
6
Licensee
ABILITY PATHWAYS INCORPORATED · Profit Corp
CDPH facility ID
240001673
License number
240000723
First licensed
February 25, 1998
Current license
Jun 21, 2026 to Jun 20, 2027
CDPH district office
San Bernardino

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
55G170
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
April 21, 1998
Last certification survey
October 1, 2025
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Private (proprietary)
Certified beds (CMS)
6
Staffing reported to CMS
RN 0.25 · LVN/LPN 1.5 · direct care 7.5 · all employees 9.25

State citations and penalties (CDPH)

1 penalty, newest first

CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained

  • Class BMedication

    Citation B (HSC 1424) · Violation Jan 8, 2007 · Penalty #240005370 · Survey 94H711

    Status: Closed · Not appealed

    $900

Federal inspections (CMS-2567)

24 surveys since 2018 · CMS data through Oct 12, 2026

CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection

Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").

  1. · Complaint

    Event 237900-H1 · no deficiencies cited

    Official 2567 ↗
  2. · Complaint

    Event 2AB239-H1 · no deficiencies cited

    Official 2567 ↗
  3. · Recertification

    Event HLQE21 · 6 deficiencies

    Official 2567 ↗
  4. · Recertification

    Event HLQE11 · 2 deficiencies

    Official 2567 ↗
  5. · Complaint

    Event R8VF11 · no deficiencies cited

    Official 2567 ↗
  6. · Complaint

    Event FWS611 · 1 deficiency

    Official 2567 ↗
  7. · Recertification

    Event CWKZ21 · 5 deficiencies

    Official 2567 ↗
  8. · Recertification

    Event CWKZ11 · 7 deficiencies

    Official 2567 ↗
  9. · Complaint

    Event 050011 · no deficiencies cited

    Official 2567 ↗
  10. · Complaint

    Event VG5911 · no deficiencies cited

    Official 2567 ↗
  11. · Complaint

    Event RLMK11 · no deficiencies cited

    Official 2567 ↗
  12. · Recertification

    Event JZ3S21 · 3 deficiencies

    Official 2567 ↗

From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.

Complaints and reported incidents

CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.

Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.

Open this facility on CalHealthFind ↗How to file a complaint with CDPH

Change history

26 events, newest first

Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.

  1. ReportFederal survey (complaint): no deficiencies(state record)

  2. ReportFederal survey (complaint): no deficiencies(state record)

  3. ReportFederal survey (recertification): 6 deficiencies(state record)

  4. ReportFederal survey (recertification): 2 deficiencies(state record)

  5. ReportFederal survey (complaint): no deficiencies(state record)

  6. ReportFederal survey (complaint): 1 deficiency(state record)

  7. ReportFederal survey (recertification): 5 deficiencies(state record)

  8. ReportFederal survey (recertification): 7 deficiencies(state record)

  9. ReportFederal survey (complaint): no deficiencies(state record)

  10. ReportFederal survey (complaint): no deficiencies(state record)

Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.