198603389-1-21-2023-28-AS-KRAZ-CNAVTK-20230121154317

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603389
Report Date: 01/21/2023
Date Signed: 01/21/2023 03:43:21 PM

Document Has Been Signed on 01/21/2023 03:43 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 IV		FACILITY NUMBER:	198603389
ADMINISTRATOR:	NWAKA, KALU		FACILITY TYPE:	735
ADDRESS:	1533 GREENPORT AVE		TELEPHONE:	(626) 364-7133
CITY:	ROWLAND HEIGHTS	STATE: CA	ZIP CODE:	91748
CAPACITY: 4		CENSUS: 3	DATE:	01/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator Kalu Nwaka		TIME COMPLETED:	03:45 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required Annual Visit focusing on COVID-19 Infection Control Practices. LPA was met by Direct Support Staff Adedolapo Olusoji and explained the purpose of the visit. Administrator Kalu Nwaka arrived shortly after to assist in the tour. The facility is licensed to serve clients aged 18 to 59 years old. There are three (3) level 4I developmentally disabled clients in the home. The facility is located in a residential area. A tour of the single-story facility includes living room, attached garage/laundry area, kitchen, dining room, 4 client bedrooms, 1 staff bedroom, 1 staff bathroom and 2 client bathrooms. Last fire drill was conducted on 11-14-2022.

LPA OBSEVATIONS:

· LPA observed signage throughout the facility which encourages cough/sneeze etiquette. LPA observed hand sanitizer throughout the facility and signage promoting frequent handwashing.

· Client bedrooms #1,2,3 and 4 all contained the required furnishings and linens. Client bedroom# 4 is currently not occupied.

· Client bathroom# 1 was observed to be clean and well stocked with paper towels and hand soap. Water temperature in bathroom# 1 was measured at 118.2 degrees F which is in the required 105 – 120 degrees F. Client bathroom# 2 was observed to be clean and well stocked with paper towels and hand soap. Water temperature in bathroom# 2 was measured at 118.3 degrees F which is in the required 105 – 120 degrees F.

· Disinfectants, cleaning solutions, poisons, sharps were observed to be locked in a hallway closet and are inaccessible to clients.

· Kitchen was observed to be clean, and appliances were observed to operable. Nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days were observed. Fire extinguisher located near the kitchen was observed to be fully charged.

· A first aid kit consists of the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual stored in the hallway cabinet.

· All medications are labeled and maintained in compliance with label instructions with State and Federal law. Medications are centrally stored and locked in the dining room cabinet.

· Outdoor and indoor passageways are free of obstruction. There are no pools or large bodies of water on the premises.

No deficiencies were observed during today's visit.

An exit interview was conducted and a copy of this report was provided to Administrator Kalu Nwaka.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 1