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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603328
Report Date: 12/19/2025
Date Signed: 12/19/2025 02:29:44 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
06/25/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250625121930
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:
12/19/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Staff Mary Jane OriemoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff left residents unattended
Staff are mismanaging residents medications
Staff are not meeting residents needs at night
Staff inappropriately turned off residents call lights at night
Staff are not providing a comfortable temperature for residents
Staff doesn't treat resident with dignity
Staff are not providing adequate food service to residents
Staff are inappropriately charging residents for assistance
Staff did not ensure the facility was free of pests
Staff did not ensure residents room was kept clean

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint visit to the facility and was met by Caregiver Mary Jane Oriemo and the purpose of the visit was discussed.
The initial visit was conducted on 07/01/25 and included the following:
Licensing Program Analyst (LPA) Glenn Trueman conducted an initial 10-day complaint visit to the facility and was met by Caregiver Jane Oriemo and the purpose of the visit was discussed.
Shortly thereafter Assistant Administrator Glenn Oriemo and Administrator Jeanine Palomares arrived.
LPA Trueman reviewed Resident R1's file and requested, Admissions Agreement. Physician's Report, Appraisal Needs and Services Plan, Emergency ID Face Sheet and MAR's Log for June 2025.
Staff and Resident Roster to be submitted.
Interviews were conducted with Resident R1 and R2. Attempts were unsuccessful to interview Resident R3 and Resident R4 who didn't respond to questioning.
Interview was conducted with Administrator telephonically.
Interviews were conducted with Caregiver Jane Oriemo and Staff S1.
At today's visit 12/19/25 Resident's R1 and R2 were interviewed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
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 5
Control Number 28-AS-20250625121930
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: 12/19/2025
NARRATIVE
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Staff S1 and Staff S2 along with Staff Mary Jane Oriemo were interviewed.
LPA reviewed file of Resident R1 and daily food requests from Resident R1 from 01/23/25 to 12/14/25 were submitted.
Weekly Bathing Schedule, Weekly Changing Schedule and Physician's Order for medication dated 10/23/2025.
In regards to the allegation Staff left residents unattended, based on interviews conducted and information gathered it was revealed that facility has adequate day and night staff to tend to residents needs.
Review of Personnel Report (LIC 500) has 3 caregivers on schedule 7AM to 7PM, 1 caregiver 7 PM to 7AM and 1 on call for each shift.
During tour of the facility including the garage LPA observed a staff bedroom in the facility and in the garage was 1 twin bed.
Staff stated that S3 or another staff are in the staff bedroom to assist residents and in the garage is Staff Mary Jane Oriemo.
Resident R2 stated there is overnight staff to assist residents.
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.

In regards to the allegation Staff are mismanaging residents medications, based on interviews conducted and information gathered physician's order 10/31/25 states to give the medication once every 72 hours for Resident R1.
Resident R2 stated he always has gotten his meds and it has always gone smoothly.
Medication Log (MAR's) for June and July 2025 list all medications as being administered for Resident R1.
Staff stated that the rules are followed strictly and Resident R1 does not want to go by the doctor's orders and will get upset if staff does not give additional medication before the 72 hours.
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.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20250625121930
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: 12/19/2025
NARRATIVE
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In regards to the allegation Staff are not meeting residents needs at night based on interviews conducted and information gathered staff stated that bedtime meds have been administered and requests for food at night are also served.
LPA reviewed MAR's Log on 07/01/25 and 12/19/25 and confirmed night time meds were administered.
Interview with Resident R2 who stated that Staff S3 is always here at night time and has provided assistance.
Tour of the facility LPA observed 1 bed in staff room adjacent to resident rooms.
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.
In regards to the allegation Staff inappropriately turned off residents call lights at night, based on interviews conducted and information gathered LPA toured the facility on 07/01/25 and 12/19/25 and did observe in the office a functioning call light system.
Staff stated that the resident hits their call button and it lights up in the office.
Said there are always sufficient staff to respond in a timely manner.
Resident R2 stated that staff are always present and respond if needed regarding the call light.
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.
In regards to the allegation Staff are not providing a comfortable temperature for residents, based on interviews conducted and information gathered during visit on 07/01/25 and 12/19/25 the facility was at a comfortable temperature meeting Title 22 Regulations.
Staff stated that the air conditioning system was set at 75F.
Also stated R1 opens the door and doesn't get the full effect of the air conditioning.
Staff also stated that they can't make it cooler because some of the residents get very cold.
Resident R2 said the temperature has always been comfortable.
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.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20250625121930
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: 12/19/2025
NARRATIVE
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In regards to the allegation Staff doesn't treat resident with dignity, based on interviews conducted and information gathered Resident R2 stated that staff are good and treat the residents well.
Said R1 is the one who is rude to staff.
Stated they are treated with dignity.
Staff stated they always provide care and are kind treating all with dignity and respect.
Administrator stated that there are many residents whose family has sent them compliments about their treatment of residents.
LPA confirmed the letters were given.
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.
In regards to the allegation Staff are not providing adequate food service to residents based on interviews conducted and information gathered daily food requests from Resident R1 from 01/23/25 to 12/14/25 were submitted and included a well balanced variety of foods.
Staff stated that staff always gave Resident R1 all that was on the food list and never complained.
LPA toured the kitchen and food supply 07/01/25 and 12/19/25 and there was a well balanced supply of chicken, fish, beef and pork.
Resident R2 said that there is always a well balanced variety of meals and has received everything from the weekly list that was submitted.
In regards to the allegation Staff are inappropriately charging residents for assistance conducted and information gathered Admission Agreement dated and signed by Resident R1 on 12/27/24 Listed Under Optional Services and checked declined it states that transportation and additional escort $30 for 1st 10 miles and .90 cents per mile thereafter. Additional escort other than the driver will be charged $20 an hour and billed to the resident in the next invoice.
Resident R2 stated he is aware of the extra fee.
Staff stated that their job is to provide care and supervision at the facility and therefore can't leave for an extended amount of time and sacrifice care for the other residents.
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.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20250625121930
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: 12/19/2025
NARRATIVE
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      In regards to the allegation Staff did not ensure the facility was free of pests, based on interviews conducted and information gathered during tour of the facility on 07/01/25 and 12/19/25 the facility was clean and there was not any pests that were observed in client bedrooms, kitchen and living room.
      Resident R2 stated that there has not been any roaches and only has observed crickets.
      Staff stated that Resident R1 will leave the door open and crickets will come in, but not roaches or other insects.
      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.
      In regards to the allegation Staff did not ensure residents room was kept clean, based on interviews conducted and information gathered review of the Cleaning Schedule Log checks off being completed under Clean and Replace for Bed Linen and Linen cover for Resident R1 and also review of HC Temp and Cleaning Log checked off as completed for Resident R1 for regular daily cleaning and also high touch surfaces.
      LPA observed all rooms to be clean and in good repair on visits conducted on 07/01/25 and 12/19/25.
      Resident R2 said they clean the room every week.
      Staff stated that rooms are cleaned every week and signed off by staff on the Cleaning Log showing which rooms were completed.
      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.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5