342700903-1-27-2023-27-AS-LKIG-CNNVTM-20230202154322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700903
Report Date: 11/30/2022
Date Signed: 01/27/2023 04:41:34 PM

Unfounded

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
10/19/2022 and conducted by Evaluator Renee Campbell

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20221019101734

FACILITY NAME:	EHIMAS RESIDENTIAL CARE		FACILITY NUMBER:	342700903
ADMINISTRATOR:	EHIMAMIEGHO, JUSTICE OSASE		FACILITY TYPE:	740
ADDRESS:	407 MAPLE STREET		TELEPHONE:	(916) 912-8042
CITY:	GALT	STATE: CA	ZIP CODE:	95632
CAPACITY:	18	CENSUS: 14	DATE:	11/30/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Justice Osase Ehimamiegho		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained injuries (including a fracture) while in care.
Facility failed to seek timely medical care

INVESTIGATION FINDINGS:

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

On this date, 01/27/2023, LPA Renee Campbell visited the facility to amend a complaint report containing inaccurate visit date.

A follow up visit from the 11/30/22 visit noted below was conducted on 01/19/22 to deliver the findings of the investigation, however dates of signatures were not corrected in the reporting system.

On 11/30/2022 at approximately 9:00 am, LPA Campbell and LPA Bilger came to facility unannounced to continue a complaint on the allegations noted above. LPA’s met with Justice Osase Ehimamiegho and explained the purpose of the visit.

During the course of the investigation LPA conducted interviews with staff and residents who reported no incidents of injury or falls. The assigned social worker reported no recent spinal injuries on the date of the incident and the alleged victim refused to grant access to his medical records for further information. In regard to any alleged assault, the victim has now reversed his story and stated no one had hurt him.

Based on interviews and record reviews, the preponderance of evidence standard is not met, and this allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies cited during visit.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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 1