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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603402
Report Date: 04/04/2023
Date Signed: 04/04/2023 03:25:46 PM

Document Has Been Signed on 04/04/2023 03:25 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 - 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: 3DATE:
04/04/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Emmanuel Ezeani TIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christine Wong conducted a Case Management visit to the facility. LPA met with DSP Emmanuel Ezeani who allowed the entry of the facility and explained the reason of the visit.

On 3/27/2023, while LPA conducted the annual inspection and LPA observed the facility was undergoing an construction which the facility administrator did not notify Licensing Agency of the proposed changes. According to the administrator, they were building an Accessory Dwelling Unites (ADU) in the back yard which will be used an staff office and its been already approved by the City and they did have the City permit about it.

According to the California Code of Regulations (Title 22, Division 6, Chapter 1), LPA observed the following deficiency and issued a citation.

An exit interview was conducted and a copy of the Report and Appeal Rights were provided to DSP Emmanuel Ezeani
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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 04/04/2023 03:25 PM - It Cannot Be Edited


Created By: Christine Wong On 04/04/2023 at 03:09 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 - HOLLY OAK DRIVE
FACILITY NUMBER: 198603402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2023
Section Cited
CCR
80086(a)

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80086 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all licensees shall notify the licensing agency of the proposed change. The requirement was not met as evidenced by:
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The administrator will ensure prior to construction or alternations, shall notify Licensing agency of the proposed change. The administrator will send the updated facility sketch to LPA by POC due date.
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LPA's observation on 03/27/2023, while LPA was conducting the annual inspection and observed the facility was undergoing the construction in the backyard which the administrator did not notify Licensing of the proposed changes
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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.
SUPERVISOR'S NAME:David Sicairos
LICENSING EVALUATOR NAME:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


LIC809 (FAS) - (06/04)
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