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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603389
Report Date: 11/04/2024
Date Signed: 11/04/2024 03:54:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/25/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20241025154440
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: 4DATE:
11/04/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Dwan MontalvoTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff engaged in physical altercation with client
Staff did not treat resident with dignity and respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint visit regarding the above allegations. LPA met with Dawn Montalvo. Administrator Nwaka, Kalu arrived shortly thereafter. LPA explained the reason for the visit.

The investigation consisted of the following: LPA interviewed the Administrator, 3 staff (S2, S3 and S4), 3 clients (C1, C2 and C3), obtained copy of the incident report which was sent to Licensing, LPA watched a video regarding the incident. Staff 1 (S1) could not be interviewed as S1 was terminated from their position.

Cont. 9099C

Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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-20241025154440
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 IV
FACILITY NUMBER: 198603389
VISIT DATE: 11/04/2024
NARRATIVE
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Allegations: Staff engaged in physical altercation with client and staff did not treat resident with dignity and respect. It was alleged that Staff had a physical altercation with the client, entering the client's bedroom and attempting to knock the phone out of client's hand.
On 08/21/24 an incident occurred in C1 bedroom involving C1 and former staff S1. LPA watched a video regarding the incident. Video shows how former staff S1 talking in a loud voice in C1's bedroom and trying to grab the phone from C1's hand while being recording. Also, it shows how another staff (S4) is blocking S1, trying to get S1 out from the room. Interviewed Administrator stated that no one informed him about the incident until 10/16/24. On 10/16/24, during a meeting with C1 and C1's Service Coordinator (SC), C1 brought on Administrator's attention that C1 had a verbal altercation with S1 and showed the video which captured on C1's phone. Also C1 reported that S1 was very rude toward C1. Administrator stated that S1 has been relieved of the duties due to that incident. Interviewed S4 stated that there were altercation between C1 and S1 about two months ago. S4 stated that he/she entered C1's room when he/she heard loud noises coming from the room. S4 witnessed that C1 and S1 were arguing about that C1 didn't clean the kitchen sink after peeling the apple. When S4 saw that S1 trying to grab the phone from C1's hand, he/she stood between S1 and C1 and tried to prevent their physical contact. Interviewed S2 and S3 stated that they heard about the incident but don't have a details. Interviewed C1 stated that they had an altercation with S1 in 08/21/24 and shows the video to LPA. Interviewed C2 and C3 stated that they aware of what happened but don't know the details. All interviewed clients stated that sometimes they feel that staff disrespectful towards them. They raise their voices at the clients.

Based on LPA's observations and interviews the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated.
See attached LIC 9099D.

Exit interview held and copies of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20241025154440
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 IV
FACILITY NUMBER: 198603389
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2024
Section Cited
CCR
80065(l)
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Personnel Requirements. Personnel shall provide for the care and safety of persons without physical or verbal abuse, exploitation or prejudice.
This requirement is not met as evidenced by the following:
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Administrator to conduct a training to the staff, to ensure that clients are accorded dignity in their personal relationships with staff. Training to be completed by POC due date and a copy of training materials and participant list with signatures to be provided to LPA via email by POC due date.
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 Based on interviews and LPA observation of a video, confirmed that there was verbal altercation at the facility between S1 and C1.
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Type B
11/12/2024
Section Cited
CCR
80072(a)(1)
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Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. The requirement was not met as evidenced :
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Administrator to conduct a training to the staff, to ensure that clients are accorded dignity in their personal relationships with staff. Training to be completed by POC due date and a copy of training materials and participant list with signatures to be provided to LPA via email by POC due date.
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Based on interviews and LPA observation of a video, confirmed that there was verbal altercation at the facility between S1 and C1. Interviewed clients stated they feel that staff disrespectful towards them. They raise their voices at the clients.
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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: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3