342700903-12-23-2024-27-AS-KHOS-DCPRHF-20250107120217

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700903
Report Date: 12/23/2024
Date Signed: 12/23/2024 12:06:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2024 and conducted by Evaluator Christina Valerio

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20241022100755

FACILITY NAME:	EHIMAS RESIDENTIAL CARE		FACILITY NUMBER:	342700903
ADMINISTRATOR:	STEPHANIE SIEWE		FACILITY TYPE:	740
ADDRESS:	407 MAPLE STREET		TELEPHONE:	(916) 912-8042
CITY:	GALT	STATE: CA	ZIP CODE:	95632
CAPACITY:	15	CENSUS: 10	DATE:	12/23/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Stephanie Siewe		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Resident developed a pressure injury due to neglect
Staff are not meeting resident's medical needs
Staff do not assist residents with obtaining transportation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a complaint investigation and deliver complaint investigation findings. LPA Valerio met with administrator Stephanie Siewe, and explained the purpose of the visit.

The following has been determined as it relates to the aforementioned allegations. The investigation consisted of staff interviews, resident interview, review of resident records, and review of facility records.

According to the Reporting Party (RP), Resident 1 (R1)had a stroke, was hospitalized, went to rehab, was discharged back to apartment, and was unable to care for herself, which resulted in R1 being hospitilized and developing an ulcer. According to RP, the facility is not getting glucose blood sugar checked, not getting blood pressure readings, and is not being assisted with medical needs or appointments.

Continues on LIC 9099 - C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024

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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Control Number 27-AS-20241022100755

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 12/23/2024

NARRATIVE

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Continued from LIC 9099

According to the review of information provided by the RP, R1 developed an ulcer, which is not a pressure injury. According to a review of R1's LIC 602, R1 was not diagnosis with a pressure injury and did not have orders for wound care. According to a review of medication orders for R1, R1 does not have an order for the facility to check blood pressure readings.

According to an interview with R1, R1 stated R1 never had any kind of wound currently and before living at Ehimas Residential Care.

According to an interview with R1, R1 does not want to go to appointment nor does R1 have any appointments. R1 stated R1 wanted to move back to R1's home. R1 stated R1 does not need any type of assistance with activities of daily living (ADL); however, R1 mentioned that staff assist with baths and toileting.

According to an interview with Staff 1 (S1) and Staff 2 (S2), the facility provides transportation for the residents if they do not have a ride. S1 stated the facility uses On Demand Mobility to schedule transportation if the facility vehicle is unavailable. LPA Valerio observed an invoice from On Deman Mobility on file at the facility.

According to S1, R1 is not agreeable to treatment. R1 has physical therapy exercises and medical appointments but will not participate. It got to a point where the medical professionals have stated they will not come out unless R1 agrees to participate. S1 says they can encourage residents but they cannot force them. According to S2, R1's social worker did not come to see R1 until months after R1 was admitted to the facility. The social worker question specific medications, such as insulin; however, R1 never had an order for it.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was left at the facility.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024

LIC9099 (FAS) - (06/04)

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