342700903-2-23-2023-27-AS-KHOS-CR8GV8-20230425054013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700903
Report Date: 02/23/2023
Date Signed: 02/23/2023 01:23:42 PM

Unsubstantiated

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
01/18/2023 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20230118092636

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:	DATE:	02/23/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Caregiver Stephanie Siewe Ehimamiegho		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff does not provide resident(s) with clean linens.

INVESTIGATION FINDINGS:

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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 met with a staff member and toured the facility including the resident bathroom, kitchen, 4 resident rooms..

During the Facility Tour, LPA and LPM noted a strong urine odor. However, clean linens were seens on the beds in residents rooms and observed clean linens stored in the laundry area. Beds were made and appeared to be clean. Although clean linen was present, a citation was issued for a broken washing machine in a case management during today's visit.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited for the allegation that the staff does not provide residents with clean linens.

Exit interview conducted. Report provided.

Unsubstantiated

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: 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.

LIC9099 (FAS) - (06/04)

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