342700903-8-30-2023-27-AS-JFAN-CV7LX9-20230830090823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700903
Report Date: 08/29/2023
Date Signed: 08/30/2023 09:09:10 AM

Document Has Been Signed on 08/30/2023 09:09 AM - 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 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:	15	CENSUS: 12	DATE:	08/29/2023
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Justice Ehimamiegho		TIME COMPLETED:	02:10 PM

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A Noncompliance Conference (NCC) was conducted today, via Microsoft Teams. The purpose of the NCC was to discuss the facilities substantiated complaint of a violation of personal rights. Present at today’s NCC were the Regional Office Manager Stephenie Doub, Licensing Program Manager (LPM) Liza King, Licensing Program Analysts (LPAs) Jennifer Fain and Maja Jensen, Karen Hicks Telecare Case Manager, and Licensee, Justice Ehimamiegho. The administrative process was explained during this meeting and Licensee was informed that further citations may result in Administrative Action.
The following issues were discussed during the conference:
· Assessment
· Appraisal and Reappraisal
· Incidental Medical care
· A substantiated complaint of a violation of personal rights.
Licensees stated they will do the following to achieve continued and substantial compliance:
· Ensure the use of emergency and nonemergency transportation as necessary to meet the needs of the residents in care

· Ensure Administrator presence for a minimum of 40 hours a week

· Maintain all resident and personal files per requirements.

Additional information provided by the licensee during the meeting included: process for assessments, process for monthly file review, plan for incontinence care, day and evening schedule for client checks,

Continued on 809 C

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Jennifer Fain	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: EHIMAS RESIDENTIAL CARE	FACILITY NUMBER: 342700903
	VISIT DATE: 08/29/2023

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In addition, as discussed during the Informal conference, the following will continue to be monitored:

· The licensee will refrain from accepting or retaining residents determined by a physician to have a primary diagnosis of a mental disorder unrelated to dementia.

· Utilize an offsite training for Mandated Reporting and de-escalation within 30 days of the informal date

· Engage the residents in the menu process within 30 days and document preferences.
· Review and amend the current incontinence plan to be approved by the Department within 90 days.

The Regional Office has agreed to continue increased monitoring.

TSP has been provided, and additional training have been requested of TSP to include
· Reporting Requirement training of all staff
Assessment and Reassessment Training of all staff

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Jennifer Fain	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC809 (FAS) - (06/04)

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