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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601425
Report Date: 05/03/2024
Date Signed: 05/03/2024 05:17:10 PM

Document Has Been Signed on 05/03/2024 05:17 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:RHEMA CARE GROUP LLCFACILITY NUMBER:
198601425
ADMINISTRATOR/
DIRECTOR:		ANGELA NWAKAFACILITY TYPE:
735
ADDRESS:975 BARSTON AVETELEPHONE:
(626) 324-3134
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY: 4CENSUS: 4DATE:
05/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:38 PM
MET WITH:Administrator Angela NwakaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analysts (LPAs) Kimberly Ramirez conducted an unannounced Annual Inspection visit on 05/03/2024. LPA Ramirez were met by Administrator Angela Nwaka and explained the purpose of the visit. This facility is licensed as an Adult Residential Facility and is serviced by San Gabriel/Pomona Regional Center. The facility is licensed to serve four (4) developmentally disabled clients ages 18 and above; of which all must be ambulatory. During today’s visit, LPA Ramirez observed one (1) direct support staff (DSP) providing direct care and supervision to clients in care. LPA Ramirez requested and obtained copies of Personnel Report, and Client Roster

LPA OBSERVATIONS: The facility is a single-story home that contains three (3) bedrooms, one (1) client bathroom, (1) staff bathroom, living room, kitchen, dining room, laundry room, backyard, and shaded patio area.

Front Yard: LPA Ramirez observed front yard to be free of hazards.

Kitchen: LPA Ramirez observed appliances to be clean and in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located kitchen cabinet, to be inaccessible to one (1) out of three (3) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to one (1) out of three (3) clients in care. Signs promoting hand washing were observed in this area. Meal plan was observed in this area for clients in care.

Dining Room/Living room: Dining room was observed to contain one table with several chairs. The living room was observed to contain plenty of lighting. LPA Ramirez observed a fully charged fire extinguisher nearby. LPA Ramirez observed nearby thermostat to read 72 degrees F. LPA Ramirez observed one (1) client sitting in this area during inspection.

SEE 809-C

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: RHEMA CARE GROUP LLC
FACILITY NUMBER: 198601425
VISIT DATE: 05/03/2024
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Linen Closet/Supply Closet: Observed to contain plenty linens, towels, and hygiene products.

Client Rooms 1 - 3: Client bedrooms #1 & 2 are private. Client bedroom#3 is shared. LPA Ramirez observed all client bedrooms to contain the required linens, furnishings, and lighting.

Bathroom 1-2: Bathroom#1 is only accessible to clients and visitors. Water temperature in bathroom was unable to be measured due to client occupying bathroom. Bathroom#2 is only accessible to staff through laundry room entrance. Water temperature in this bathroom was measured at 105.6 F degrees. LPA gained entry onto bathroom#2 through client bedroom#3. This bathroom has a two-way entry which leads into the facility laundry room. LPA gained entry into laundry room through this open door. LPA Ramirez observed disinfectants, cleaning solutions and laundry detergent accessible to 1 out of 3 clients in care. LPA Ramirez will issue Type A deficiency based on observation.

Backyard: No large bodies of water were observed.

Emergency Drills: Last documented disaster drill was conducted on 02/05/2024 and 12/12/2023.

Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide and smoke detectors in hallways. Smoke detectors were observed to be operable during visit. Fully charged fire extinguishers were observed throughout the facility.

Personnel Records: Personnel records are maintained at the facility. LPA Ramirez reviewed two (2) personnel records. First Aid Certificate, Fingerprint Clearance/ Exemptions, Personnel Record/Job Application, Health Screening, Employee Rights, TB Test, and Initial/Annual Training Verification. Back up Administrator’s certificate for Gideon Etudoh Imeh was observed with an expiration date of 01/19/2025.

Client Records: Client files are maintained at the facility. LPA Ramirez reviewed three (3) client records. No deficiency was observed. Admissions Agreement, Medical Assessment, Consent Forms, Appraisal and Needs and Services plan, I.D and Emergency Information, TB Test, Centrally Stored Medication Record, and Personal Rights Form.

Infection Control Plan: LPA Ramirez was unable to access infection control plan. Administrator will email Infection Control Plan to LPA Ramirez within 7 days.

One (1) deficiency was cited today. Exit interview was conducted. A copy of this report, 809-D, and appeals rights was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/03/2024 05:17 PM - It Cannot Be Edited


Created By: Kimberly Ramirez On 05/03/2024 at 02:56 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: 05/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, laundry room containing disinfectants and cleaning solutions was accessible through staff bathrom,the licensee did not comply with the section cited above in 1 out of 6 clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/04/2024
Plan of Correction
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*Staff locked door to staff bathroom as to prevent accessibility to clients in care. This clears 24hr correction.*
Administrator will re-train staff on the above regulation. Proof of training must be submitted via fax to LPA Ramirez bu 05/13/2024.
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:Tony Vasallo
LICENSING EVALUATOR NAME:Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024


LIC809 (FAS) - (06/04)
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