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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700903
Report Date: 03/24/2023
Date Signed: 03/24/2023 05:10:26 PM


Document Has Been Signed on 03/24/2023 05:10 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: DATE:
03/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Isaiah TrotterTIME COMPLETED:
05:00 PM
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On 3/24/23 at approximately 11:30am Licensing Program Analyst Maja Jensen arrived at facility to conduct a case management related to an observation made during a site visit on 3/19/23.

On 3/19/23 LPA Jensen was conducting interviews with Resident who advised she had a pre-existing injury-a foot fracture. LPA Jensen observed some swelling to the foot. R1 stated she was not in pain and did not want a cast as a cast may cause atrophy. LPA Jensen also observed R1 had an overgrown toe nail that was overgrown by approximately 1 inch however R1 again denied experiencing pain. LPA Jensen returned on this day to conduct a case management for R1.

LPA Jensen requested the file for Resident 1 (R1) and reviewed all records. LPA Jensen interviewed site manager and was advised that the facility has a podiatrist that visits the facility however the podiatrist has not been at the facility since R1 was admitted which was approximately 4 weeks ago. LPA Jensen again interviewed R1 and recommended podiatry care. R1 declined assistance with seeking medical attention for the toe. R1 confirmed she recently had an appointment with her PCP but was unable to complete the appointment as she did not have her ID and insurance. R1 is being established as a new patient with a local Primary Care Provider (PCP). The site manager has confirmed they will assist R1 in establishing as new patient and getting seen by the PCP.

LPA Jensen also returned 2 resident files for Resident 2 and Resident 3 that were taken to the Regional Office for the purpose of making copies in relation to separate complaint investigation.

No deficiencies are being cited as a result of this case management. An exit interview was conducted and a copy of this report was given to care staff Isaiah Trotter.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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