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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601856
Report Date: 04/27/2023
Date Signed: 04/27/2023 07:16:06 PM

Document Has Been Signed on 04/27/2023 07:16 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 LLC IIFACILITY NUMBER:
198601856
ADMINISTRATOR:KALU NWAKAFACILITY TYPE:
735
ADDRESS:755 WALNUTHAVEN DRIVETELEPHONE:
(818) 824-0340
CITY:WEST COVINASTATE: CAZIP CODE:
91790
CAPACITY: 4CENSUS: 4DATE:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tega UgeyiaeTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with Administrator Tega Ugbeyiae who allowed the entry of the facility and assisted with the visit. The purpose for the visit was explained. The facility is licensed to serve four (4) ambulatory clients ages 18-59.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and here are the domains that LPA inspected:

1, Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting the clients. Staff are cleaning and disinfecting at least once or twice for high touched surface area. Facility has sufficient PPE supplies and has an Infection Control Plan.
2. Physical Plant and Environmental: The facility is a single story house and located around the residential neighborhood area. The facility includes: living room, four clients bedrooms, two bathrooms, staff office, dining area, kitchen and detached garage. LPA inspected the carbon monoxide detectors and its mounted on the wall near the kitchen care. The smoke detectors are located in each bedroom and common area and they are all interconnected and working properly. LPA tested the hot water in two bathrooms and they are tested between 108.5 and 109.5 degrees F and its within the Title 22 regulation. All the sharp knives and utensils are locked in the file cabinet next to the kitchen. All the chemicals and cleaning supplies are locked in the hallway cabinet. The facility has ample personal hygiene products for clients. All the clients rooms are clean and furnished and have required beddings.
3. Operational Requirements: The facility maintained a fire clearance approved by the fire department which four ambulatory client and currently all clients in the facility are ambulatory. The facility also has shaded area with table and chairs for client to utilize for outdoor activity. The last fire/disaster drill were conducted on 3/11/23.
(See LIC 809C for continuation)
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: RHEMA CARE GROUP LLC II
FACILITY NUMBER: 198601856
VISIT DATE: 04/27/2023
NARRATIVE
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4. Staffing: The facility has sufficient staffing but for the night supervision staff does not have any updated planned emergency training.
5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. The administrator's Tega Ugbeyiae certificate will be expired on 7/23/24. The administrator also has an updated HIV and TB Training. All the direct care staff has the updated first aid training and Medication Management Training.
6. Clients Right-Information: The facility does not have any client required postural support. The facility does serve adults has internet service shall provide at least one access device.
7. Client Records-Incident Reports: All the client files are maintained in the facility. All the files have the required documents included: admission agreement, updated physician report , Individual Personal Plan (IPP) and functional capacity assessment..etc.
8. Food Service: The facility has two days perishable and seven days non-perishable food supply. The refrigerator is maintained in the required temperature. All the food are stored probably.
9. Health Related Services: All client medication are centrally stored and locked next to the file cabinet next to the kitchen. All the client's medication are reviewed and they are all seemed accurate and updated.
10. Incidental Medical Services: The facility does not have any client who has the restricted health condition or prohibited health condition.
11. Disaster Preparedness: The facility has an updated emergency disaster plan (LIC610D) posed with contact numbers and at least two relocation sites but staff does not have annual emergency preparedness training and the fire drill /disaster drill did not indicate the type of emergency covered by the drill and names of the staff participating in the drill.
12. Emergency Intervention: All staff have required training including the CPI and CPR training and they are all updated.

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 1

Exit interview was conducted, Appeals Rights discussed and a copy of the report was given to the administrator Tega Ugeyiae
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 04/27/2023 07:16 PM - It Cannot Be Edited


Created By: Christine Wong On 04/27/2023 at 03:39 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 II
FACILITY NUMBER: 198601856

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85065.6(b)(1)
Night Supervision
(b) Employees providing night supervision from 10:00 p.m. to 7:00 a.m., as specified in (c) through (f) below, shall be available to assist in the care and supervision of clients in the event of an emergency, and shall have received training in the following: (1) The facility's planned emergency procedures.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed, LPA did not observe staff#1 and #2 has any training for planned emergency procedures which posed a potential risk to clients in care
POC Due Date: 05/11/2023
Plan of Correction
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The adminsitrator will ensure the NOC shift staff would receive training on planned emergency procedures annually and send the training log to LPA by POC Due date.
Type B
Section Cited
HSC
1565(b)
Other Provisions
(b) If a facility employs staff, the facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed, LPA observed all staff did not have any annual training for staff responsibilities during emergency or disaster which posed a potential risck to clients in care.
POC Due Date: 05/11/2023
Plan of Correction
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The adminsitrator would ensure all staff receive annual training for staff responsibilities during an emergency or disaster and send the staff training log to LPA by POC due date.
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:David Sicairos
LICENSING EVALUATOR NAME:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 04/27/2023 07:16 PM - It Cannot Be Edited


Created By: Christine Wong On 04/27/2023 at 03:39 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 II
FACILITY NUMBER: 198601856

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1565(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA observed the facility has a fire/disaster drill but on the drill, it did not indicate any of emergency covered by the drill and names of the staff participating in the drill whcih posed a potenital risk to the clients in care.
POC Due Date: 05/11/2023
Plan of Correction
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The administrator will ensure on the fire /disaster drill has to document of the drill include the date, type of emergency and name of staff participate in the drill and send the staff training log to LPA 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:David Sicairos
LICENSING EVALUATOR NAME:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023


LIC809 (FAS) - (06/04)
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