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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603328
Report Date: 12/23/2025
Date Signed: 12/23/2025 03:08:12 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
12/18/2025 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251218170054
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: 5DATE:
12/23/2025
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Pol Palomares - DSP TIME COMPLETED:
03:22 PM
ALLEGATION(S):
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Staff are not ensuring that resident's hygiene needs are being met while in care.
Staff do not ensure that residents are provided clean linens while in care.
Staff do not ensure that resident is being provided comfortable accomodations while in care.
Staff do not ensure that resident is being provided safe accomodations while in care.
Licensee does not ensure that staff are adequately trained.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced complaint visit to address the allegations listed above. LPA met with Pol Palomares, DSP for the facility, and explained the purpose of the visit. Assistant Administrator Glen Oriemo arrived shortly thereafter.

The investigation consisted of the following: LPA conducted a tour of the facility including all resident bedrooms and the bathroom, interviewed residents #1 - 4 (R1 - R4), Staff #1 - 3 (S1 - S3), Witness #1 (W1), and also obtained the weekly shower schedule, linen change schedule, and copy of the admission agreement for residents, along with the staff trainings for the staff members. LPA attempted to interview Resident #5 (R5), however they were hospitalized at the time of the visit.

The investigation revealed the following: In regards to the allegation that "Staff are not ensureing that resident's hygiene needs are being met, it is alleged that residents are not being assisted with showering, washing residents hair, and shaving of their legs.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
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 3
Control Number 28-AS-20251218170054
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: A FAITHFUL HOME OF COVINA
FACILITY NUMBER: 198603328
VISIT DATE: 12/23/2025
NARRATIVE
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During interviews with the residents, three (3) out of four (4) did not corroborate the allegation. One of the residents stated that the staff have been helping them with all of their care needs including showering. Another resident stated that staff have been assisting them with bathing and that they have never had any issues with having their hygiene needs met. During interviews with staff, none of them corroborated the allegation. One staff stated that all residents are showered three (3) to four (4) times per week, or as needed and that they have a schedule for showering all residents to meet their hygiene needs. Another staff member also confirmed that they assist residents with showering at least three (3) times per week or per request of the resident. Review of the weekly bathing schedule for residents revealed that all have been showered at least three (3) times for the week of 12/15/2025 - 12/22/2025.

In regards to the allegation that "Staff do not ensure that residents are provided clean linens while in care," it is alleged that staff are providing dirty linens to residents in care. During interviews with the residents, none of them corroborated the allegation. One of the residents stated their linens are always kept clean by staff. Another resident also corroborated that their linens are cleaned by staff. During interviews with the staff, none of them corroborated the allegation. One of the staff stated that linens are cleaned at least once per week for all residents as indicated on the admissions agreement, or as needed. Another staff member also stated that linens are cleaned at least once per week or more if they become dirty. During the tour of the resident bedrooms, all linens appeared to be clean upon inspection. The admissions agreement also specifies that linens are to be cleaned at least once per week by staff.

In regards to the allegation that "Staff do not ensure that resident is being provided comfortable accommodations while in care," it is alleged R1 was provided a mattress in which they are able to feel their own bedsprings and therefore is not comfortable. During interviews with the residents, three (3) out of four (4) of them did not corroborate the allegation. One of the residents stated that their mattress is comfortable and they have no problems with it. Another resident stated that they believe their mattress is adequate. During interviews with the staff, none of them corroborated the allegation. One staff stated that R1's home health agency is working towards submitting a request for a hospital bed with a new mattress to R1's Primary Care Provider (PCP) for approval, and in the meantime the facility is providing R1 a temporary mattress. Another staff member also stated that the resident mattresses are comfortable and are working towards obtaining a new mattress for R1. During interview with W1 who works at R1's home health agency, they confirmed that they are working on submitting the request to R1's PCP in order to obtain a hospital bed with new mattress for R1.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20251218170054
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: A FAITHFUL HOME OF COVINA
FACILITY NUMBER: 198603328
VISIT DATE: 12/23/2025
NARRATIVE
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In regards to the allegation that "Staff do not ensure that resident is being provided safe accommodations while in care," it is alleged that R1 had been dropped while being assisted with a shower by a staff member. During interviews with residents, three (3) out of four (4) did not corroborate the allegation. One resident stated that they have never been harmed by any staff in any way while living in the facility. Another resident stated that they have never been hurt while residing in the facility. During interviews with staff, none of them corroborated the allegation. One of the staff members stated that none of the residents have been dropped or fallen in the shower recently. Another staff member stated that no incidents of residents being dropped in the shower have occurred recently, and that caregivers transfer residents from bed to wheelchair, then from wheelchair to shower chair to avoid any instances of residents falling while showering. During the tour of the restroom, LPA observed that the restroom has a slip-resistant mat and grab bars as required by Title 22 regulations.

In regards to the allegation that "Licensee does not ensure that staff are adequately trained," it is alleged that staff do not have required training including CPR training. During interviews with residents, none of them corroborated the allegation. One resident stated that they believe staff are trained well and treat the residents well. Another resident also stated that staff are trained and perform their duties well. During interviews with staff, none of them corroborated the allegation. One of the staff stated that they all have undergone required training including medication administration training. Another staff stated all staff have CPR certificates along with required dementia care training. During record review of staff training, LPA observed that all staff have required CPR training along with required annual training related to dementia care, hospice care, restricted health conditions, postural supports, and medication administration.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3