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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603402
Report Date: 12/17/2024
Date Signed: 12/17/2024 11:49:30 AM

Unsubstantiated


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
12/11/2024 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241211114036
FACILITY NAME:RHEMA CARE GROUP LLC - HOLLY OAK DRIVEFACILITY NUMBER:
198603402
ADMINISTRATOR:IRHIA, BLESSINGFACILITY TYPE:
735
ADDRESS:1820 E HOLLY OAK DRIVETELEPHONE:
(626) 426-5904
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:4CENSUS: 4DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:John Wilson-Ekaun, AdministratorTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Staff physically assaulted resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced 10-day complaint visit at the facility and met with Administrator, John Wilson-Ekaun to discuss the purpose for today's visit. The purpose of the visit is to investigate the above allegation.

The investigation consisted of the following: LPA interviewed the Administrator, Staff #1 (S1) - Staff #3 (S3). LPA also interviewed Client #1 (C1) - Client #3 (C3) on the phone. LPA interviewed Client #4 (C4) at the home. LPA interviewed Witness #1 (W1) and Witness #2 (W2) on the phone. LPA obtained copies from Client #1 (C1) file such as Physician's Report, Face Sheet, IPP, Client Notes, Data Tracking Index, and Special Incident Reports.

The investigation revealed the following: in regard to the allegation "Staff physically assaulted resident", it is alleged that C1 was physically assaulted by a male staff member on 12/10/2024 around midnight. It is alleged that C1 was kicked four times by the male staff member. This incident allegedly resulted in causing a red mark approximately 2 inches long on C1’s right cheek. No other details were provided.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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 2
Control Number 28-AS-20241211114036
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 - HOLLY OAK DRIVE
FACILITY NUMBER: 198603402
VISIT DATE: 12/17/2024
NARRATIVE
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Four (4) out of Four (4) staff interviewed all denied the allegation and indicated that they have never physically assaulted clients in care nor have they observed any other staff members get physically assaulted in care. Two (2) out of four (4) clients denied the allegations. LPA interviewed C1 and C1 stated being kicked by staff and reported to the director. LPA interviewed C4 stated that C1 got in a physical altercation with staff and that C4 did not get in any physical altercation and feels safe at the home. Administrator, and S1 to S3 interviewed indicated that on 12/10/2024 around 8pm, C1 and C4 got in a physical altercation and S2 separated the two clients. S2 and S3 both stated that they witnessed C1 and C4 get in a physical altercation and S2 separating the two clients. Interview with W1 indicated that C1 has a history of fabrication and making false accusations and getting in physical altercations with clients. Based on record review, LPA observed C1 fabricating stories and false accusations. S1 to S3 both indicated that they did not notice any injuries at the time of incident but the 2-inch mark was noticed the next day on 12/11/2024. Interview with W2 also indicated that C1 has a history of fabrication and making false accusations. When Administrator was notified about the incident, Administrator sent the Special Incident Report (SIR) to San Gabriel Pomona Regional Center and Community Care Licensing on 12/11/2024. The SIR indicated that the Administrator put S1 on suspension and scheduled training this month as facility conducted investigation of the incident. San Gabriel Pomona Regional Center conducted their investigation on 12/11/2024 and delivered unsubstantiated findings on 12/16/2024. S1 was off suspension as of 12/16/2024 and resuming work on 12/17/2024.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided to the Administrator, John Wilson-Ekaun.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2