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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601425
Report Date: 04/14/2022
Date Signed: 04/14/2022 04:32:15 PM

Document Has Been Signed on 04/14/2022 04:32 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:RHEMA CARE GROUP LLCFACILITY NUMBER:
198601425
ADMINISTRATOR:ANGELA NWAKAFACILITY TYPE:
735
ADDRESS:975 BARSTON AVETELEPHONE:
(626) 324-3134
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY: 4CENSUS: 4DATE:
04/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Angela Nwaka, AdministratorTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Tao and Calderon conducted an unannounced annual visit. LPAs met with Administrator, Angela Nwaka who assisted with the visit. The facility is licensed to serve four (4) Developmentally Disabled Adult clients (ages 18-59), ambulatory only. Currently, there are four (4) clients in placement. The clients receive services from San Gabriel/Pomona Regional Center. LPAs discussed with administrator regarding the purpose of today's visit and the inspection.

During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed.

The facility is a single-story house located in a residential neighborhood. LPA toured the facilities physical plant, indoor and outdoor. Facility consists of three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, laundry room, garage and an indoor/outdoor activity area. Passageways and exits are free of obstruction. Client rooms are furnished with appropriate furniture for clients’ comfort. Bathrooms are operational and furnished with grab bars and nonskid surfaces. Common areas are observed for the ability to safely serve the needs of the clients. A shaded area with chairs is provided in the back yard. The yard is free of debris/ hazard. Kitchen appliances are clean and were operating at the time of the visit. Sufficient supply of perishable and nonperishable foods is observed. Smoke detectors and carbon monoxide detector are operable and in compliance. Fire extinguisher is purchased on 4/14/22 and are fully charged. The first aid kit is fully stocked. Hot water temperature measured at 105.7 degrees Fahrenheit which is within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies are observed. The last Fire/ Emergency Drill was conducted on 04/02/22. Medications are centrally stored, locked and the records are current. Hazardous items are locked and inaccessible to clients. Annual licensing fee is current.

Deficiencies were observed per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator, Angela Nwaka, who’s signature on this form confirm receipt of these documents. A copy of LIC 809s report and appeal rights were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
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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Document Has Been Signed on 04/14/2022 04:32 PM - It Cannot Be Edited


Created By: Bonnie Tao On 04/14/2022 at 02:34 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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: RHEMA CARE GROUP LLC
FACILITY NUMBER: 198601425

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
LPAs saw five (5) live cockroaches were running across the bulletin board on the wall behind the sofa.
Backyard’s metal screen door has rust and is deteriorated.
Laundry room’s sliding door screen is ripped. 
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/20/2022
Plan of Correction
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Licensee agreed to replace the rusted screen door and screen on the laundry room sliding door. Licensee is going to hire pest control to fumigate the facility. Licensee will send a copy of the job invoices, pictures of the fixed screen door and a picture of fixed sliding door to Licensing by the POC due date. Licensee will send a copy of the pest control invoice and clearance letter regading the cockroaches issue by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Fernando Fierros
LICENSING EVALUATOR NAME:Bonnie Tao
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022


LIC809 (FAS) - (06/04)
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