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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002840
Report Date: 04/24/2023
Date Signed: 04/24/2023 05:33:54 PM


Document Has Been Signed on 04/24/2023 05:33 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 NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:ELIZABETH CARE HOMES IVFACILITY NUMBER:
345002840
ADMINISTRATOR:EKANEM, UWEM IMEFACILITY TYPE:
740
ADDRESS:7131 MATHIS COURTTELEPHONE:
(650) 248-1108
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 5DATE:
04/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Franca Offor, Administrator TIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to continue a complaint investigation. LPA met with Ezema "Peter" Ositadimma and Nneka Uchegbu, caregivers, and explained purpose of inspection. LPA met with Franca Offor, Co-Administrator, who arrived at 3:15 pm.

While at the facility, LPA observed resident (R1) to be stating to LPA, staff and residents she wants to leave the facility. Administrator contacted R1's son and and attempted to contact another family member.

At 5:00 pm, R1 went outside in the street and was immediately followed by a care staff (S1). LPA observed S1 to be in the street, near the driveway to the facility. LPA was informed at 5:15 pm that a neighbor called law enforcement to handle the escalating situation. LPA was informed R1 showed similar behavior just (3) days ago. LPA observed resident (R1) return inside the facility at 5:30 pm with staff (S1).

Co-Administrator and LPA contacted Administrator, Ime, and explained the situation and R1's behavior this afternoon. Administrator agreed to contact the physician's office and request R1's scheduled medical appointment on 4/28/23, be moved up to earlier this week.

Also discussed was designating another staff to act on Co-Administrator's behalf if she is occupied at another facility when LPA arrives to conduct an inspection.

Also discussed the facility completing and submitting incident reports to report R1's behavior.

There are no deficiencies issues on this report at this time.

Exit interview. Copy of repot provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2023
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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