342701253-7-15-2026-27-AS-RJAY-DVZQM6-20260715121702

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701253
Report Date: 07/15/2026
Date Signed: 07/15/2026 12:17:47 PM

Document Has Been Signed on 07/15/2026 12:17 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:	IKENNA CARE HOME		FACILITY NUMBER:	342701253
ADMINISTRATOR/ DIRECTOR:	OFODIRE, UZODINMA		FACILITY TYPE:	735
ADDRESS:	9866 FALCON MEADOW DR.		TELEPHONE:	(713) 516-4867
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY: 4		CENSUS: 4	DATE:	07/15/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Administrator Uzodinma Ofodire		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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	On 7/15/2026 at 9:00 am Licensing Program Analyst (LPA) Reza Jamaly arrived unannounced at the facility to conduct required 1 year visit. LPA met with staff on duty Gillian Tabukum, identified self and explained the purpose of the visit. Gillian helped LPA tour the facility, then administrator Uzodinma Ofodire arrived at 9:20 am. The facility is licensed to serve 4 non-ambulatory adults between the ages of 18 and 59 years. At the time of the inspection, there were 4 residents in care and 3 staff members on duty. Residents were at day program at the time of inspection. LPA conducted a tour of the interior and exterior of the facility. The inspection included kitchen, two bathrooms, resident's bedrooms, dining room, living room, medication storage area, laundry room, garage and all outdoor areas. The facility was observed to be clean, organized, and maintained in a safe and sanitary condition. Passageways, exits, and walkways were free of obstructions. The temperature inside the facility was observed to be at 73F which is within the required range of 68-85F. Water temperature measured 126.8°F, which is not within the required range of 105°F to 120°F, . Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers were fully charged and last serviced on 2/5/2026. Emergency exits were accessible, and emergency evacuation plans were posted. Continues on LIC 809C on page 2

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Reza Jamaly
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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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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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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: IKENNA CARE HOME	FACILITY NUMBER: 342701253
	VISIT DATE: 07/15/2026

NARRATIVE

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LPAs observed an adequate supply of perishable and nonperishable food to meet residents' nutritional needs. Kitchen appliances were operational, and food was properly stored, freezer temperature observed to be at -1 degree F and refrigerator temperature was 37 degree F which are in compliance.
Sharps, cleaning solutions, toxins, and other hazardous materials were stored in a manner that prevented resident access.
Medications were centrally stored in a locked location and inaccessible to residents.
Resident bedrooms were furnished with the required furniture, including beds, mattresses, dressers, and sufficient lighting. Bedding and linens were clean and in good condition. Bathrooms were clean, operational, supplied with soap and paper towels, and maintained in a sanitary condition.
Facility is maintaining electronic or soft copies of residents and staff records. LPA requested residents and staff records for review. LPA reviewed 4 out of 4 resident's file and found them to be complete. 3 out of 4 staff files were reviewed and found to be complete. A review of personnel records confirmed that all staff members and other individuals required to undergo caregiver background checks had received criminal record clearances and were properly associated with the facility.
The following documents were requested and will be emailed to the LPA by 7/22/2026 no later than 5:00 PM.:

LIC 308 – Designation of Administrative Responsibility
Copy of the Administrator Certificate
LIC 610 – Emergency Disaster Plan
Proof of Current Liability Insurance
LIC 500 – Personnel Report
LIC 309 – Administrative Organization

As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, So, one type B deficiencies were issued and the deficiencies can be found on the LIC 809-D page. An exit interview was conducted with administrator and a copy this report and Appeals rights were provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Reza Jamaly
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/15/2026 12:17 PM - It Cannot Be Edited

Created By: Reza Jamaly On 07/15/2026 at 11:48 AM

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: IKENNA CARE HOME	FACILITY NUMBER: 342701253
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80088(e)(1)

80088(e)(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on the observation, the licensee did not comply with the section cited above because the water tempreture in one of the resident's bathroom was checked and observed to be 126.8 degree F which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/25/2026
	Plan of Correction
1 2 3 4	Administrator immediately adjust the water heater to make sure that hot water dose not exceed 120 degree F. Administrator also will provide training for direct care staff on maintaining safe hot water tempretures and will send copy of training to LPA by due date.

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:

	Reza Jamaly
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC809 (FAS) - (06/04)

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