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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700903
Report Date: 11/02/2023
Date Signed: 11/02/2023 04:10:43 PM


Document Has Been Signed on 11/02/2023 04:10 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:15CENSUS: 15DATE:
11/02/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Justice EhimamieghoTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility to conduct a quarterly case management visit. LPA met with Administrator Justice Ehimamiegho, and explained the purpose of the visit.
Based on the Non Compliance Conference (NCC) on 4/12/23 the following areas will be assessed:
    · The Administrator is present for a minimum of 40 hours a week - Based on records review, LPA Valerio determined that the Administrator is present for a minimum of 40 hours per week. LPA received notification that facility staff Stephanie received her administrator certificate. LPA observed documents and clarified that the correct documentation has been completed and he needs to send to LPA via email/fax.

    · The licensee has not accepted any residents determined by a physician to have a primary diagnosis of a mental disorder unrelated to dementia - LPA observed one resident to be admitted after 08/2023. The resident did not have a primary diagnosis of a mental health disorder unrelated to dementia.

    · The licensee ensured that they are in compliance with the state Fire Marshall; The facility has a non ambulatory fire clearance for each room that will be used to accommodate a resident with dementia - LPA confirmed that they are within compliance.

    · Meals were observed during the visit. LPA did not observe meal time; however, LPA observed a left over plate, which had pasta shells with sauce, vegetables and ground meat and a half turkey sandwich. LPA conducted observations of the meal prep area, freezer, refrigerator were conducted. LPA observed the meal prep area to have a resident's plate with name since the person did not eat yet. LPA observed the freezer and refrigerator to be fully stocked and clean from debris or spoiled food. TA was provided on a separate 809 for an emergency supply of food.


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.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
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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