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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603389
Report Date: 02/01/2024
Date Signed: 02/02/2024 10:30:49 AM

Document Has Been Signed on 02/02/2024 10:30 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:RHEMA CARE GROUP LLC IVFACILITY NUMBER:
198603389
ADMINISTRATOR:NWAKA, KALUFACILITY TYPE:
735
ADDRESS:1533 GREENPORT AVETELEPHONE:
(626) 364-7133
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 4CENSUS: 3DATE:
02/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Aloy Ohia TIME COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced required Annual Visit. LPA was met by Direct Support Staff Aloy Ohia and explained the purpose of the visit. The facility is licensed to serve clients aged 18 to 59 years old. 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 11/15/23.

The following was observed : 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 120 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 120 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. Medications were reviewed, and appear to be administered as prescribed. 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.

Deficiencies on attached 809-D. Copy of report and appeal rights provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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 02/02/2024 10:30 AM - It Cannot Be Edited


Created By: Angelica Rea On 02/01/2024 at 04:52 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 IV
FACILITY NUMBER: 198603389

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80069(a)(1)


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 3 out of 3 client files which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/05/2024
Plan of Correction
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Administrator will ensure that medical assessments are available for review at the facility as required. Administrator will send proof of client medical assessments for client #1 - client #3 by POC due date.
Type A
Section Cited
CCR
80066


This requirement is not met as evidenced by: LPA was advised by staff that the staff files were not at the facility.
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 3 out of 3 staff files requested which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/05/2024
Plan of Correction
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Administrator will ensure that staff files are available for review upon request by community care licensing as required. Administrator will send proof of staff files 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:Lisa Hicks
LICENSING EVALUATOR NAME:Angelica Rea
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024


LIC809 (FAS) - (06/04)
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