<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700903
Report Date: 02/12/2024
Date Signed: 02/12/2024 10:43:28 AM


Document Has Been Signed on 02/12/2024 10:43 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 CAREFACILITY NUMBER:
342700903
ADMINISTRATOR:STEPHANIE SIEWEFACILITY TYPE:
740
ADDRESS:407 MAPLE STREETTELEPHONE:
(916) 912-8042
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:15CENSUS: 12DATE:
02/12/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Stephanie SieweTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Christina Valerio arrived to the facility to conduct a quarterly case management visit. LPA met with Administrator Stephanie Siewe, 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 Stephanie Siewe is present for a minimum of 40 hours per week.

    · The licensee has not accepted any residents determined by a physician to have a primary diagnosis of a mental disorder unrelated to dementia - According to Administrator Stephanie, There have been no new admissions since the last quarterly visit.

    · 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 - On 01/02/2024, The facility received an updated fire clearance. The facility has a fire clearance for 15 individuals considered non ambulatory.

    · Meals were observed during the visit. Today, the residents were provided pancakes, eggs, sausage, and fruit slices for breakfast. Drinks included milk, juice, water, and coffee. According to Administrator Stephanie, she will prepare turkey sandwiches, chips, and homemade potato salad with drinks for lunch. LPA observed the facility to have an emergency supply of food and water.

    · Training for Mandated Reporting and De-escalation. LPA observed training files. The last training on Mandated Reporting and De-Escalation was provided on 12/08/2023


Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited today.

An exit interview was held with Administrator Stephanie, 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: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1