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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700903
Report Date: 10/05/2022
Date Signed: 10/05/2022 04:28:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/17/2022 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20220817141052
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:18CENSUS: 14DATE:
10/05/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Justice Ehimamiegho, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents sleep in wet beds and clothes
Facility Staff are not adequately supervising residents
Facility staff are not ensuring that residents diapers are changed
Facility is in disrepair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/05/2022 at 9:45 am, LPA Campbell and LPA Bilger came to facility unannounced to continue a complaint investigation for the allegations noted above. LPA's met with Administrator Justice Ehimamiegho and explained the purpose of the visit. During the course of this investigation, four residents, Administrator and three staff were interviewed as well as a facility observation 08/19/22, 08/31/22 and 10/05/22. LPA's reviewed facility menu and staffing schedule.

Allegation #3 Residents sleep in wet beds and clothes.
Allegation #4 Facility Staff are not adequately supervising residents and
Allegation #5 Staff are not ensuring diapers are changed.
Based on interviews and observations, it was determined that night staff do not consistently change clients overnight and residents clothes and bedding are soaked through by morning. LPA also observed a strong smell of urine during the first investigative visit on 08/31/22. Based on interviews, it was determined residents have to change their diapers overnight if they are able. Due to a preponderance of evidence, this allegation is SUBSTANTIATED.

Allegation 6, Facility is in disrepair. LPA observed bathrooms had no lightbulbs, there was a crack in one of the toilets and the area around the toilet base was chipped and cratered. Paint in the dining area was chipped and had food stains. Due to a preponderance of evidence, this allegation is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/17/2022 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20220817141052

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:18CENSUS: 14DATE:
10/05/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Justice Ehimamiegho, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff does not ensure that residents clothing is changed
Facility staff does not ensure that residents brush their teeth
Facility staff member yells at residents
Facility staff does not have sufficient staff to meets resident needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Allegation #1: Facility staff does not ensure that residents’ clothing is changed. LPA interviewed staff and residents as noted above and conducted facility observation. Based on interviews and observations, it was determined that residents are adequately clothed and contain adequate amounts of clothing on hand for personal use. Interviews revealed that residents clothing is changed daily to meet their needs. As a result, there is not a preponderance of evidence to conclude residents’ clothing is not being changed. Therefore, this allegation is UNSUBSTANTIATED.
Allegation #2: Facility staff does not ensure that residents brush their teeth: LPA interviewed staff and residents as noted above and conducted facility observation. Based on interviews and observation, it was determined that residents in care receive oral hygiene assistance including brushing of teeth. Furthermore, it was determined that residents engage in self oral care as able to do so. Additionally, it was determined that residents contain adequate amounts of oral hygiene products available for use. As a result, there is not a preponderance of evidence to conclude that facility staff is not ensuring that residents brush their teeth, therefore, this allegation is UNSUBSTANTIATED.
Allegation #7: Facility staff member yells at residents. LPA interviewed staff and residents as noted above and conducted facility observation. LPAs observed staff interaction with residents. Based on interviews and observation, it was determined that there have been no confirmed experiences of staff yelling at residents in care. Interviews revealed no reports of staff yelling at residents. Based on interviews and observation, there is not a preponderance of evidence to conclude the above allegation occurred, therefore, this allegation is UNSUBSTANTIATED.
Allegation #8: Facility staff does not have sufficient staff to meet resident needs. LPA reviewed staffing schedule and interviewed staff and residents as noted above. LPA also conducted a facility observation. Based on record review and interview, it was determined that facility staff are present based on published staffing schedule across all shifts. Observations revealed 2 staff members and Administrator present consistently to meet needs of residents. As a result, there is not a preponderance of evidence to conclude that facility is not meeting needs based on level of staffing. Therefore, this allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20220817141052
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 342700903
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/08/2022
Section Cited
CCR
87411(a)
1
2
3
4
5
6
7
87411(a) Facility personnel shall all times be ... competent to provide the services necessary to meet resident needs...



This requirement is not met as evidenced by
1
2
3
4
5
6
7
Licensee will conduct staff training on incontinent care and provide the staff training materials used along with proof of completed training (staff sign in sheet) by POC due date. Licensee will notify LPA of training date on 10/12/2022.
8
9
10
11
12
13
14
Based on observation, interviews and record review, the licensee did not ensure adequate personnel provided incontinent care overnight. This poses a potential Health, Safety or Personal Rights risk to residents in care..
8
9
10
11
12
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14
Deficiency Dismissed
Type B
11/08/2022
Section Cited
CCR
87625(b)(3)
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5
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7
87625(b)(3) ... the licensee shall be responsible for ... Ensuring that incontinent residents are kept clean and dry and ... the facility remains free of odors from incontinence.
This requrement is not met as evidenced by

1
2
3
4
5
6
7
Licensee will conduct staff training on incontinent care and provide the staff training materials used along with proof of completed training (staff sign in sheet) by POC due date. Licensee will read regulations and provide a signed declaration of understanding by POC due date.
8
9
10
11
12
13
14
Based on observation and interviews, the licensee did not ensure residents were kept clean and dry resulting in a strong urine odor.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20220817141052
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 342700903
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/08/2022
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
87303(a) Maintenance Operation. The facility shall be clean, safe, sanitary and in good repair at all times.


This requirement is not met as evidenced by
1
2
3
4
5
6
7
Licensee will ensure dining room walls are cleaned, chipped drywall repaired and repainted and install secure light fixtures in the bathroom. Licensee will take pictures once the changes are made and email LPA at renee.campbell@dss.ca.gov
8
9
10
11
12
13
14
Based on observation and interviews, the licensee has not conducted basic maintenance for the bathrooms and dining room walls.
8
9
10
11
12
13
14
Request Denied
Type B
11/08/2022
Section Cited
CCR
87625(b)(2)
1
2
3
4
5
6
7
87625(b)(2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night.

This requirement is not met as evidenced by
1
2
3
4
5
6
7
Licensee will conduct staff training on incontinent care and provide the staff training materials used along with proof of completed training (staff sign in sheet) by POC due date. Licensee will read regulations and provide a signed declaration of understanding to LPA by POC due date.
8
9
10
11
12
13
14
Based on observation and interviews, the licensee did not ensure overnight staff adequately checked and changed residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4