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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603328
Report Date: 11/14/2024
Date Signed: 11/14/2024 05:17:10 PM

Unsubstantiated


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
11/05/2024 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20241105194857
FACILITY NAME:A FAITHFUL HOME OF COVINAFACILITY NUMBER:
198603328
ADMINISTRATOR:DUONG, THANGFACILITY TYPE:
740
ADDRESS:1084 W GROVECENTER ST.TELEPHONE:
(626) 244-9999
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY:6CENSUS: 4DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Thang Steven Duong, Licensee/administratorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff did not arrange transportation for resident following doctors visit.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint visit to investigate the complaint allegation. During today’s visit, LPA met and explained the purpose of today's visit to administrator assistant, Elizah Arganosa.

The investigation consisted of the following: interviews of staff from staff #1 (S1) through staff #3 (S3); interviews of residents from resident#1 (R1) to resident#4 (R4); reviews of resident#1’s record, and physical plant was conducted. LPA obtained copies of staff/resident rosters; and resident files for resident #1 (R1) with relevant information.

Regarding to the allegation, staff did not arrange transportation for resident following doctors' visit, it was alleged that staff failed to arrange transportation for a resident to return to the facility after doctor’s appointment. The investigation revealed of the following:
(- Continued on LIC 9099 C-)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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-20241105194857
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: A FAITHFUL HOME OF COVINA
FACILITY NUMBER: 198603328
VISIT DATE: 11/14/2024
NARRATIVE
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Per residents' interviews, four (4) out of four (4) residents could not corroborate the allegation. Three (3) residents stated staff helped them to arrange transportation to medical appointments. One resident said resident's responsible party arranged the transportation from the resident. Per staff interviews, all three (3) staff denied the allegation. It revealed staff assisted three (3) residents to arrange transportation to and from doctors’ appointments and one resident had the responsible party to arrange for the resident. Per record review, the incident report dated 10/28/24 indicated resident’s transportation was arranged by the responsible party but the driver failed to pick up the resident after the doctor appointment. Therefore, the responsible party called 911 for help. Thus, staff did not fail to arrange transportation for resident following doctors visit.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegation mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with administrator Steven and findings were discussed. A copy this report was provided at the time of visit.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
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