198603328-10-23-2025-28-AS-FFIS-DMR2YT-20251023174915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603328
Report Date: 10/23/2025
Date Signed: 10/23/2025 12:36:25 PM

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
06/09/2025 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250609100405

FACILITY NAME:	A FAITHFUL HOME OF COVINA		FACILITY NUMBER:	198603328
ADMINISTRATOR:	DUONG, THANG		FACILITY TYPE:	740
ADDRESS:	1084 W GROVECENTER ST.		TELEPHONE:	(626) 244-9999
CITY:	COVINA	STATE: CA	ZIP CODE:	91722
CAPACITY:	6	CENSUS: 6	DATE:	10/23/2025
		UNANNOUNCED	TIME BEGAN:	11:16 AM
MET WITH:	Direct Staff Person-Jane Oriemo		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility staff verbally abusing resident
Facility staff not assisting resident with their ADLs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) S Vaid conducted a subsequential complaint visit to the facility and was met by Direct staff Person(DSP)-Jane Oriemo. Glen Oriemo, assistant administrator, was notified and the purpose of the visit was discussed.

On 6/17/2025, LPA Vaid requested, obtained and reviewed the following documents. Staff and resident rosters, physicians report, pre-placement appraisal, Needs and service plan, Emanate Health visit dated 6/16/25, admissions agreement, weekly linen changing schedule, weekly bathing schedule, AFHC COVID 19 cleaning and disinfection log, 06/01/25 to present. Contact number for Home Health agency.

The investigation revealed:

CONTINUED ON 9099C............

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250609100405

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: A FAITHFUL HOME OF COVINA	FACILITY NUMBER: 198603328
	VISIT DATE: 10/23/2025

NARRATIVE

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Regarding the allegation: Facility staff verbally abused resident. It is alleged that staff verbally abused a resident in care by calling the resident degrading names and yelling at them. Four (4) out of four (4) staff interviewed deny this allegation, the staff stated they are all professionals’ caregivers here they do not call the residents names but treat them with respect and dignity, and have never raised their voice at the residents, only raised voice when residents cannot hear them. According to R1’s needs and service plan dated 7/15/24, R1 has hearing problems and needs hearing aid. During interview with R1, they did not wear their hearing device. LPA was made to speak loudly. Four (4) of five (5) residents interviewed could not corroborate this allegation, residents stated the staff does not yell at them nor make fun of their medical condition. Residents stated staff makes them feel safe and comfortable. Based on interviews conducted, records reviewed, and observations made. 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.

Regarding the allegation: Facility staff not assisting resident with their ADLs. It is alleged that the facility staff are not assisting R1 with their ADLs (assisted daily living) needs and not providing R1 with a wheelchair and R1 is being forced to walk on their own. Four (4) out of four (4) staff interviewed deny this allegation, staff stated the wheelchair R1 brought with them when they moved in was repossessed by previous skilled nursing facility. Administrator stated new wheelchair was purchased on behalf of R1 by new Home Health agency. LPA observed wheelchair in R1’s room. According to the weekly bathing schedule for month of June 2025, R1 refused to shower nor allow staff to assist R1 with their ADLs. Staff stated they will attempt throughout the day to convince residents to bathe. Four (4) of five (5) residents interviewed stated they are assisted by staff with ADLs and get assisted with walking when needed. Based on interviews conducted, records reviewed, and observations made. 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.

Copy of this report was signed and provided to Jane Oriemo, Direct staff Person (DSP)

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

LIC9099 (FAS) - (06/04)

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