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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700903
Report Date: 02/23/2023
Date Signed: 02/23/2023 01:14:05 PM


Document Has Been Signed on 02/23/2023 01:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CAREFACILITY NUMBER:
342700903
ADMINISTRATOR:EHIMAMIEGHO, JUSTICE OSASEFACILITY TYPE:
740
ADDRESS:407 MAPLE STREETTELEPHONE:
(916) 912-8042
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:18CENSUS: 15DATE:
02/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Stephenie EhimamieghoTIME COMPLETED:
01:00 PM
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
Licensing Program Analyst (LPA) Renee Campbell and Licensing Program Manager (LPM) Liza King arrived at the facility at 10:54 am to follow up on a complaint investigation. LPM toured the facility including the resident bathroom, kitchen, resident rooms and reviewed 2 Resident files, further follow up is needed. Beds were made and appeared to be clean with no presense of saturation. An odor of urine was however present throughout the facility. LPM and LPA observed the activity in the facility for approximately an hour and casually spoke to residents. During the facility tour, the LPM observed One resident room which contained a tape like fly trap hanging from the ceiling covered in dead flies photo taken. During the tour and interview, a staff member reported that the washing machine is inoperable and facility staff are doing laundry off site, which may be a factor in the odor of the building.

Based on the above observations, a citation was issued. An exit interview was conducted with the staff member and report was provided via email to Justice, during the visit..

SUPERVISOR'S NAME: Krystall MooreTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 02/23/2023 01:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/23/2023
Section Cited

1
2
3
4
5
6
7
Personal Rights:(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:

(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.The facility failed to meet this as evidenced by:
A fly trap full of dead flies was hanging from the ceiling in the middle of a resident room.
1
2
3
4
5
6
7
Fly trap was removed during visit.
Type B
03/02/2023
Section Cited

1
2
3
4
5
6
7
Maintenance and Operation:
(g) Facilities which have machines and do their own laundry shall:

(1) Have adequate supplies available and equipment maintained in good repair.

This was not met as evidenced by an inoperable washing machine.
1
2
3
4
5
6
7
Facility will provide proof of repqair or relacement within 7 days to renee.campbell@dss.ca.gov

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Krystall MooreTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2