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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700903
Report Date: 10/29/2024
Date Signed: 10/29/2024 04:00:46 PM

Document Has Been Signed on 10/29/2024 04:00 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EHIMAS RESIDENTIAL CAREFACILITY NUMBER:
342700903
ADMINISTRATOR/
DIRECTOR:		STEPHANIE SIEWEFACILITY TYPE:
740
ADDRESS:407 MAPLE STREETTELEPHONE:
(916) 912-8042
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 15CENSUS: 11DATE:
10/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Stephanie SieweTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with Administrator Stephanie Siewe, and explained the purpose of the visit.

LPA Valerio and Administrator Stephanie toured the facility to ensure compliance with Title 22 regulations. LPA Valerio inspected eight (8) resident bedrooms. Resident bedrooms were observed to be fully furnished and appeared to have linens that were clean. The rooms were free from odors. Resident bathrooms were equipped with hand soap, paper towels, toilet paper, trash can, and hygiene supplies. Hot water was measured in the bathroom. Water faucets delivered hot water at 113.6 degrees F, which is within the required regulatory range. Common areas were observed to be fully furnished. The common rooms had a temperature of 76 degrees, which is within the required regulatory range. The fire extinguisher located in the kitchen and near the front entrance door to be within compliance with the last maintenance check on 10/02/2024. The kitchen was observed to be clean with sharps and chemicals locked and inaccessible to residents. Medication cabinets were locked. LPA Valerio inspected the food supply in the kitchen and in the shed refrigerator. The facility was observed to have a food supply that meets the requirements of a two day supply of perishable food items and a seven day food supply of non-perishable food items. Lunch today was observed to be top ramen and a turkey sandwich with cheese and vegetables.

LPA Valerio reviewed five (5) staff files and five (5) resident files. LPA Valerio requested the following annual documentation: LIC 500, LIC 308, LIC610E, and copy of liability insurance

Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited today. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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