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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700903
Report Date: 08/14/2025
Date Signed: 08/14/2025 12:17:43 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/01/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250801160942
FACILITY NAME:EHIMAS RESIDENTIAL CAREFACILITY NUMBER:
342700903
ADMINISTRATOR:STEPHANIE SIEWEFACILITY TYPE:
740
ADDRESS:407 MAPLE STREETTELEPHONE:
(916) 912-8042
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:15CENSUS: 15DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Justice Ehimamiegho TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff is not ensuring that medication is dispensed and prescribed to resident in care as necessary.
INVESTIGATION FINDINGS:
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On 08/14/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the community to present findings for a complaint. LPA Campbell met with Licensee, Justice Ehimamiegho and explained the purpose of the visit.

Regarding the allegation that staff is not ensuring that medication is dispensed and prescribed to resident in care as necessary, it was reported that R1's prescription (rx) had not been picked up since 11/2024 per R1's doctor. When LPA Campbell attempted to interview R1, R1 did not remember LPA Campbell from prior visits last week and R1 claimed her medication was fine. W1, a family friend stated R1 had trouble with long term memory. This was reiterated by the licensee. LPA Campbell reviewed R1's Medication Administration Record (MAR) and only saw a recent rx for Lisinopril from 08/2025. It was the first rx for Lisinopril since 11/2024. LPA Campbell observed the incident reported and fax confirmation report submitted by the community on 02/2025 which illustrated their continued attempts to request a new rx from the doctor without a response. The pharmacy also stated that a non-response from doctor can mean the rx is not be refilled.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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 2
Control Number 27-AS-20250801160942
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: EHIMAS RESIDENTIAL CARE
FACILITY NUMBER: 342700903
VISIT DATE: 08/14/2025
NARRATIVE
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Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies cited.  Exit interview was held and a copy of report was given to Licensee, Justice Ehimamiegho.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2