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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601425
Report Date: 04/07/2023
Date Signed: 04/07/2023 03:17:36 PM

Document Has Been Signed on 04/07/2023 03:17 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
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: 3DATE:
04/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit. LPA 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. The clients receive services from San Gabriel/Pomona Regional Center. Annual licensing fee is current. LPA discussed with administrator regarding the purpose of today's visit and the inspection.

During the visit, the CARE tool was used, staff and clients were interviewed, a tour of the facility was conducted, food supply was reviewed, and medication/staff files/client files 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 operable 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 are observed. Smoke detectors and carbon monoxide detector are operable and in compliance. Fire extinguisher is purchased on 01/04/23 and are fully charged. The first aid kit is fully stocked. Hot water temperature measured at 112.7 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 02/14/23. Medications are centrally stored, locked and the records are current. Hazardous items are locked and inaccessible to clients. Administrator certificate is current with expiration date on 03/01/2024.
(-Continued in LIC 809C-)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 LLC
FACILITY NUMBER: 198601425
VISIT DATE: 04/07/2023
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No 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 809 report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
LIC809 (FAS) - (06/04)
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