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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601425
Report Date: 02/15/2024
Date Signed: 02/15/2024 01:04:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/08/2024 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20240208084755
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
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Angela Nwaka, administratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff did not administer resident's medication as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Tao conducted an unannounced complaint visit to the facility. Upon arrival, LPA met Angela Nwaka, Administrator and explained the purpose of the visit to staff.
During today's visit, LPA obtained a copy of the staff/client roster, client#1’s file and client#1’s medical records.

The investigation consisted of staff interview and client file review.
In regards to the allegation: staff did not administer resident's medication as prescribed, it was alleged that on 12/30/23, client#1 (C1) had a medication, Lorazepam 1mg, which was prescribed to administer for 14 consecutive days. The investigation revealed that client#1’s medication records indicated client #1’s Lorazepam 1mg was administered for two days as PRN on 01/03/24 and 01/04/24.

(- continue to LIC9099C -)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST 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.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20240208084755
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 02/15/2024
NARRATIVE
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Per staff interview, staff confirmed that C1's medication, Lorazepam 1mg was administered to C1 on 01/03/24 and 01/04/24 as PRN which did not administer for 14 days as prescribed. It was due to miscommunication between the administrator and C1's physician.

Based on LPA's file review and interview, the investigation revealed that the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview conducted with Angela Nwaka, Administrator and a copy of this report and appeal rights provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST 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
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240208084755
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2024
Section Cited
CCR
80075(b)(5)(B)
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80075(b)(5)(B) Once ordered by the physician the medication is given according to the physician's directions.

This requirement is not met evidenced by:
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Licensee shall provide (1) additional medication administration assistance training to all Staff and provide proof to the department;
(2) review Title 22, Section 80075(b)(5)(B) and provide a signed statement indicating the review of this section detailing how to
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Medication records review and interview revealed that on 01/12/24, physician prescribed medication Lorazepam 1mg for Client #1 as administered for 14 days consecutively but staff administered the Rx as PRN for 2 days on 1/3/24 & 1/4/24.
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prevent future medication errors on shift by the POC date.
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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.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3