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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602378
Report Date: 08/13/2024
Date Signed: 08/13/2024 11:32:03 AM

Document Has Been Signed on 08/13/2024 11:32 AM - 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 IIIFACILITY NUMBER:
198602378
ADMINISTRATOR/
DIRECTOR:		NWAKA, KALUFACILITY TYPE:
735
ADDRESS:1999 WRIGHT STREETTELEPHONE:
(818) 824-0340
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY: 4CENSUS: 4DATE:
08/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:47 AM
MET WITH:Jennifer Ogudu - Direct Care StaffTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Jennifer Ogudu and explained the reason for the visit.

The facility is licensed to serve 4 ambulatory adults between the ages of 18 to 59 years old. The facility is located in a residential neighborhood and consists of (3) bedrooms, 1 1/2 bathrooms, kitchen, dining area, living room, front, backyard, and an attached garage.

LPA conducted a tour of the facility with Jennifer Ogudu and observed the following:
Kitchen was observed in good repair, sufficient non-perishable supplies were observed for at least 7 days, perishables were observed for at least 2 days. Dining room/living room were observed clean with sufficient seating area. Medication and sharps were observed locked in cabinets in the living room. Cleaning supplies are stored in garage an inaccessible to clients. LPA observed two client bedrooms which have the sufficient bedding supplies, lighting, and required furniture. Room #2 was not observed as client was sleeping and did not allow access. Smoke/Carbon monoxide detector in room #1(R1) was observed without batteries and beeping at the time of the visit, and in room #3(R3) was observed removed. Bathrooms were observed clean, in good repair, and water temperature was tested between 108.4-111.9 degrees F., which is within the required 105-120 degrees F. Backyard has a covered seating area. Fire extinguisher was observed. First aid kit was reviewed.

Infection Control Plan was reviewed a copy was requested. Emergency Disaster plan was reviewed and last updated on 5/2/23. Last Fire Drill was conducted on 5/24/24 and conducted quarterly. Administrator certificate was observed for Gideon Imeh #6058468735 exp. date: 1/19/25.

LPA reviewed 4 client files, P&I money for 3 clients, and medication for 1 client. Client #1 and #3 do not have a physician's report/TB test clearance on file. Staff files were reviewed for 4 staff. (CONT. LIC 809C)
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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Document Has Been Signed on 08/13/2024 11:32 AM - It Cannot Be Edited


Created By: Mary G Flores On 08/13/2024 at 11:16 AM
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 III
FACILITY NUMBER: 198602378

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1503.2
General Provisions
Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 2 out of 2 rooms observed had issues with smoke/carbon monoxide detector, R1 was missing batteries, and R3 was missing the detector which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/20/2024
Plan of Correction
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Administrator will replace smoke/carbon monoxide detector and batteries and submit a picture to the department by POC due date 8/20/24.
Type B
Section Cited
CCR
80069(c)
Client Medical Assessments
(c) The medical assessment shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 4 clients do not have a physician's report or TB test clearance which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/27/2024
Plan of Correction
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Administrator will obtain physician's report and TB test
for C1 and C3 and will submit a copy to the department by POC due date 8/27/24.
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:Mary G Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


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 III
FACILITY NUMBER: 198602378
VISIT DATE: 08/13/2024
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Facility does not serve clients with health restrictions or postural supports. All clients are receiving services from the Regional Center. LPA interviewed 2 staff and 2 clients.

Deficiencies noted on LIC 809D per Title 22 Regulations.

Exit interview was conducted with administrator and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
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