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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700903
Report Date: 08/31/2022
Date Signed: 10/05/2022 10:36:16 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/17/2022 and conducted by Evaluator Renee Campbell
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220817141052
FACILITY NAME:EHIMAS RESIDENTIAL CAREFACILITY NUMBER:
342700903
ADMINISTRATOR:EHIMAMIEGHO, JUSTICE OSASEFACILITY TYPE:
740
ADDRESS:407 MAPLE STREETTELEPHONE:
(916) 912-8042
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:18CENSUS: 14DATE:
08/31/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Justice EhimamieghoTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility dishes are not properly washed
Facility does not provide residents adequate food (no snacks).
INVESTIGATION FINDINGS:
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On 08/31//2022 at 10 am, LPA Campbell and LPA Bilger came to facility unannounced to continue a complaint investigation for the allegations noted above. LPA's met with Administrator Justice Ehimamiegho and explained the purpose of the visit. Facility observation was completed on 8-19-22. In addition, Administrator and Staff1 (S1) were interviewed on 8-19-22.

Allegation #1 Facility dishes are not properly washed. Based on interviews, it was determined that facility dishwasher was not functioning properly for over 1 week.. LPA observed that staff was hand washing dishes and based on interview found that they were not using a proper sanitizing agent per regulatory requirements.. As a result, the preponderance of evidence standard is met, therefore this allegations is SUBSTANTIATED.
Allegation #2 Facility does not provide residents adequate food (no snacks). During a tour of the facility's kitchen area and outside storage area, LPA observed a locked shed. When staff opened the shed upon request, LPA observed an inadequate amount of snacks necessary for the amount of people in the facility. Additionally, LPA observed an inadquate amount of snacks available in the kitchen area. Based on observation, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
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 27-AS-20220817141052
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: EHIMAS RESIDENTIAL CARE
FACILITY NUMBER: 342700903
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2022
Section Cited
CCR
87555(b)(3)
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General Food Service (b) The following food service requirements shall apply: (3)
Between-meal nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician. This requirement was not met as evidenced by
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Facility will submit 30 days worth of food receipts indicating the amounts of food provided.
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Based on observation, facility did not maintain adequate amounts of snacks for residents in care. This poses a potential health and safety risk for residents in care.
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Type B
08/31/2022
Section Cited
CCR
87555(b)(31)(B)
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General Food Service (b)The following food service requirements shall apply: (31) Dishes and utensils shall be disinfected: (B) In facilities not using mechanical means,... the addition of a sanitation agent to the final rinse water. This requiremebnt was not met as evidenced by
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Facility will buy a new dishwasher that will maintain hot water at a minimum temperature of 170 degrees F (77 degrees C) at the final rinse cycle of diswashing machines or have a plan in place approved by the Department to sanitize without a dishwasher.
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Based on observation and interview, Facility did not use a sanitation agent while hand washing dishes in the final rinse. This poses a potential health and safety risk for residents 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.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3