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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602378
Report Date: 04/10/2025
Date Signed: 04/10/2025 12:38:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
04/04/2025 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250404150707
FACILITY NAME:RHEMA CARE GROUP LLC IIIFACILITY NUMBER:
198602378
ADMINISTRATOR:NWAKA, KALUFACILITY TYPE:
735
ADDRESS:1999 WRIGHT STREETTELEPHONE:
(818) 824-0340
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:4CENSUS: 3DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Imeh Etudoh Gideon, AdministratorTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Facility staff mismanaged residents' medications.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Daniel Konishi and Gabriela Castro conducted an unannounced Initial 10-Day complaint investigation visit regarding the above allegation. LPAs discussed the purpose of the visit with Administrator, Imeh Etudoh Gideon.

The investigation consisted of the following: LPAs requested a copy of staff and client rosters. LPA interviewed Admin, Staff #1 (S1) to Staff #3 (S3), and Client #1 (C1) to Client #3. LPAs reviewed medication records for C1 and C3. LPA docs requested C1: Face sheet, Physician’s Report, Physician’s Orders, Medication Administration Records (MAR – January 2025 to April 2025), and IPP. LPA requested copies of S1 and Staff #2 (S2’s) file such as: valid First Aid, CPI training, and medication training. LPA also requested staff training documents and special incident reports.

[Continue to LIC-9099-C]
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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-20250404150707
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: RHEMA CARE GROUP LLC III
FACILITY NUMBER: 198602378
VISIT DATE: 04/10/2025
NARRATIVE
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The investigation revealed the following in regards to the allegation: “Facility staff mismanaged resident’s medication.” It is alleged that on March 26, 2025, the Administrator received a call from S1 reporting that S2 had inadvertently administered C1 medication after S1 had already given the prescribed dose earlier that morning. The time interval between the two administrations reported was two hours. Administrator immediately directed that C1 be taken to the emergency room (ER) for evaluation. Admin, and three (3) out of three (3) staff all corroborated with the allegation. All staff interviewed admit that a medical error did occur on the date of the incident. Admin stated that S2 was taken off shift and suspended for two weeks. Admin immediately scheduled medication administration training for all staff and the training program being instructed by a licensed professional. Two (2) out of three (3) clients interviewed denied the allegation and stated that they have no issues with medications being mismanaged by the staff. One (1) out of three (3) clients interviewed stated not receiving any medication management.
In addition, SGPRC conducted an investigation regarding this allegation which was substantiated. As a result of this, the Administrator re-trained medication management for all staff from 3/31/2025 and an ongoing program. Based on observations, record review, and interviews conducted with facility staff, and facility residents, there was sufficient supportive evidence to concur with the reported allegation.

Based on LPA interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.



An exit interview was conducted with the Administrator, Imeh Etudoh Gideon. A copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250404150707
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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: 04/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/11/2025
Section Cited
CCR
80075(b)
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(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement is not met as evidenced by:
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Administrator will retrain staff that pass out medications and will submit training materials and sign in sheets discussed to the LPA by the POC due date.
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This requirement is not met with the facility as on March 26, 2025, the Administrator received a call from S1 reporting that S2 had inadvertently administered C1 medication after S1 had already given the prescribed dose earlier that morning. The time interval between the two administrations reported was two hours. This poses an immediate health, safety, or personal rights risk to persons in care.
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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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
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