347005264-9-23-2020-27-AS-SDOB-BTYV8X-20201001161329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005264
Report Date: 09/22/2020
Date Signed: 09/23/2020 02:56:06 PM

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
04/08/2020 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20200408154350

FACILITY NAME:	STAINLESS RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	347005264
ADMINISTRATOR:	JUSTICE O EHIMAMIEGHO		FACILITY TYPE:	740
ADDRESS:	407 MAPLE STREET		TELEPHONE:	(916) 821-2391
CITY:	GALT	STATE: CA	ZIP CODE:	95632
CAPACITY:	18	CENSUS: 13	DATE:	09/22/2020
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Administrator Justice O Ehimamiegho		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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Unannounced complaint visit (Call) via conference September 22, 2020. LPA Lund talked to Administrator, Justice O Ehimamiegho and explained the reason for the call.
Current census is 13 residents.

The purpose of this via conference is to complete the investigation and present findings to the Administrator Justice O Ehimamiegho regarding the allegations of “Illegal eviction.”

During the course of the investigation, LPA conducted interviews with staff and witnesses. LPA reviewed facility records, Resident (R1) medical records and Unusual Incident/Injury Reports (UIR-LIC 624) from R1.

On March 31, 2020 the facility sent R1 back to the hospital because R1 conditions could not be met by the facility. During R1 stay at Kaiser South Hospital Sacramento the facility and Kaiser had constant contact regarding R1 medical conditions. Kaiser Hospital had concerns that the facility would not take back R1 when R1 was medically cleared to comeback to facility. During Kaiser’s communications with the facility Licensee Princess Amas-Johnson and Administrator Justice O Ehimamiegho did expressing their concerns about R1 and the facility being able to meet the needs of R1.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20200408154350

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: STAINLESS RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 347005264
	VISIT DATE: 09/22/2020

NARRATIVE

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Based on Interviews, review of records, medical records and Unusual Incident/Injury Reports (UIR-LIC 624) the facility did express their concerns to Kaiser about taking R1 back from the hospital. The facility did take R1 back from the hospital on April 15, 2020 when R1 was medically cleared to go back to the facility.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
There were no deficiencies observed or cited at this time.

An exit interview was conducted with Administrator Justice O Ehimamiegho via telephone and a copy of this report was provided to Administrator Justice O Ehimamiegho via email and an electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020

LIC9099 (FAS) - (06/04)

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