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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601425
Report Date: 02/15/2024
Date Signed: 02/15/2024 01:09:39 PM

Document Has Been Signed on 02/15/2024 01:09 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:
02/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Angela Nwaka, administratorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Bonnie Tao conducted an unannounced Case Management- Incident visit in response to Client (C1’s) Incident Report dated 5/4/23 and Client#2 (C2's) incident report dated 2/9/24 that was submitted by Angela Nwaka, Administrator. Those reports was for clients' death. LPA explained the purpose of today's visit to Administrator, who assisted with this visit.

During today's visit LPA toured the facility, interviewed Administrator and reviewed C1's and C2's files. The C1's incident report stated C1 deceased in hospital due to kidney failure. Responsible parties and regional center were notified. The C2's incident report stated C2 passed away at the facility due to cardio arrested which was expected per physician notes dated 1/12/24. Responsible parties and regional center were notified. LPA did not observe nor identify signs of neglect, abuse or other immediate health and safety threats. LPA obtained copies of the following documents:
· Staff/client rosters
· C1’s and C2's Medication Administration Records (MAR)/ Physician report
· C1’s and C2's Unusual Incident Reports
· C1’s and C2's Identification/Emergency Contact Information (facesheet)
· C1’s and C2's Individual Program Plans (IPP)
· C2's Doctor notes.
LPA requested the following documents be submitted upon receipt:
· Death Reports of C1 and C2

The department will continue to gather additional information and will return to complete the investigation. Exit interview held and a copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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