342701164-8-4-2026-27-AS-AVIA-DWMS5A-20260804133401

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701164
Report Date: 08/04/2026
Date Signed: 08/04/2026 01:34:35 PM

Document Has Been Signed on 08/04/2026 01:34 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	CHIDIKE CARE HOME LLC		FACILITY NUMBER:	342701164
ADMINISTRATOR/ DIRECTOR:	OGECHUKWU ESOMONU		FACILITY TYPE:	735
ADDRESS:	8520 SUNRISE WOODS WAY		TELEPHONE:	(916) 478-1844
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY: 4		CENSUS: 4	DATE:	08/04/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Chisom Iwunze		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

NARRATIVE

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On August 4, 2026, Licensing Program Analysts Arvin Villanueva (LPA), arrived unannounced at this facility to conduct the annual inspection visit. LPA initially met with staff on duty, Chisom Iwunze (S1) and stated the purpose of the visit. The licensee was notified and authorized staff on duty to assist with the annual inspection and sign this report. Upon arrival, there were two clients in care with one staff member on duty (S1). Per staff, the other clients were out in the community at this time. The other staff on duty, Divine Nze (S2) arrived at approximately 10am.

Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 4 ambulatory adult residents. Facility does not have clearance for non-ambulatory, bedridden, delayed egress, and locked exterior/interior.

Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident units, resident bathrooms, dining room and outdoor areas.

LPA and S2 inspected 2 of 4 resident bedrooms and 2 of 3 bathrooms. Hot water temperature was measured in 2 of 3 bathrooms. One hallway bathroom was measured at 100 degrees Fahrenheit; per S2, this was reported to the administrator and a repair is on schedule. . A repair person came during this visit to repair the hot water. LPA rechecked the hot water and measured at 105 degrees Fahrenheit. The other hallway bathroom was measured at 108 degrees Fahrenheit

Hallway temperature was maintained at 72 degrees Fahrenheit during this visit. No fire door was observed.

In the kitchen area, LPAs observed at least 7-day nonperishable and 2-day perishable food supplies. Advisory was provided to obtain a thermometer for each of their refrigerator and freezer. Knives/sharps and cleaning solutions were locked. Fire extinguishers observed and last serviced on 5/12/2026. Smoke detectors were observed throughout and at least one carbon monoxide detector was observed. One carbon monoxide detector was tested and found to be working. Medication cabinet was observed to be locked and not accessible to residents.

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Stephen Richardson
Arvin Villanueva
	DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

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: CHIDIKE CARE HOME LLC	FACILITY NUMBER: 342701164
	VISIT DATE: 08/04/2026

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Outdoor area was inspected. Walkways and ramps were unobstructed. Fences and the exit gate were observed to be in good repair at this time. No bodies of water were observed at this time. LPA observed a shaded area and chairs for outdoor activities. Regarding shut off valves, advisory was provided to facility to ensure all staff know the location of each of the valves and know how to operate each valve in case of emergency.
Record Reviews:
Review of 4 of 4 client files was conducted, including but not limited to, review of Admission Agreement, Physician Reports, and Ambulatory Status. Per review of Physician’s Reports dated 10/17/25, Client-1 (R1) was assessed as non-ambulatory. Additionally, review of R1’s Admission Agreement dated 10/20/2025, R1 was assessed as non-ambulatory by Alta California Regional Center, due to R1 “unable to follow emergency directions/prompts.” Per interview with staff and licensee, R1 is able to follow directions during emergency drill. Licensee was advised that this should have been caught prior to admission.
Medication review was conducted for 2 clients, including review of resident’s medication, PRN authorization letter, prescription records, Centrally Stored Medication Records, and Medication Administration Records. Advisory was provided to facility to obtain written documentation regarding clients’ ability to determine or communicate their need for PRN medication.
Review of 3 staff files included but not limited to background clearance, first aid/CPR certification, and training. Per review of Guardian, these 2 staff were associated to this facility.
Facility conducts monthly Fire Drill, and last fire drill was on 7/7/2026. Advisory was provided to conduct other types of disaster drills as required. First aid kit was complete.
Interviews: 1 staff members and 1 residents in care.
Documents Requested: LPA requested a copy of updated Liability Insurance, Surety Bond, Personnel Records (LIC500), and Designation of Facility Responsibility (LIC308) to be emailed.
Per the California Code of Regulations, Title 22, Division 6, Chapter 6 and Health and Safety Code deficiencies were cited. This facility is hereby assessed an immediate civil penalty in the amount of $500 due to fire clearance violation. Advisories were provided.
Plan of correction and appeals were discussed with Licensee. Exit interview with S1. A copy of the report and appeal rights were provided.
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NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/04/2026 01:34 PM - It Cannot Be Edited

Created By: Arvin Villanueva On 08/04/2026 at 12:57 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: CHIDIKE CARE HOME LLC	FACILITY NUMBER: 342701164
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/04/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80020(a)

Fire Clearance

(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (interview) (record review), the licensee did not comply with the section cited above. Per review of Physician's Report and Admission Agreement, Client-1 (R1) was assessed as non-ambulatory and this facility do not have fire clearance for non-ambulatory rooms, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/05/2026
	Plan of Correction
1 2 3 4	Per discussion with licensee, R1 is ambulatory because R1 is able to be prompted to leave during emergency drills. Licensee was advised that this should have been caught prior to admissioin. Licensee will develop a plan to prevent reoccurance of this oversight. Plan to be submitted by POC due date. Licensee agreed to have R1 reassessed by their physician and by Alta California Regional Center and submit the new assessments once completed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:

	Arvin Villanueva
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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