198603328-6-26-2026-28-AS-FFIS-DVV4KA-20260710191000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603328
Report Date: 06/16/2026
Date Signed: 06/26/2026 02:59:02 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
01/28/2026 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260128145756

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: 4	DATE:	06/16/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Glen Oriemo, Lead CareGiver		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not administer medication as prescribed
Staff did not provide an adequate amount of meals to a resident in care.
Staff did not complete required training.
Staff did not prevent medications from being inaccessible to residents in care.
Staff did not maintain a comfortable temperature for residents in care.
Staff did not ensure that resident is provided adequate bedding.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vaid conducted subsequent visit to the facility to deliver the findings for the above-mentioned allegations. LPA Vaid toured the facility with House lead caregiver Glen Oriemo and did not observe any health and safety concerns. Administrator was unavailable. Obtained residents and staff rosters.

On 02/02/2026, Licensing Program Analyst (LPA) Vaid conducted initial investigation and was met by Administrator Glen Orimeo and the reason for the visit was discussed. LPA Vaid toured the facility with the administrator and did not observe any health or safety concerns. LPA Vaid requested and obtained for review the following documents, staff and resident roster, residents physician report, R1-medication record and medication administered record, physician orders for medications, admissions agreement. Three (3) Unusual incident reports, weekly bathing schedules for January 2026 and February 2026, staff cleaning schedule log for January and February 2026, weekly linen changing schedules for February 2026, three (3) employee certificates with training dates, R1 letter to Administrator, email with R1's home health regarding new topper mattress qualification.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026

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-20260128145756

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: 06/16/2026

NARRATIVE

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1.Regarding the allegation: Staff did not administer medication as prescribed. It is alleged that the facility staff is not administering residents’ medication as prescribed by residents’ physicians. Three of three staff deny this allegation. Staff stated residents are administered the correct dosage of medications as prescribed by the residents’ physician orders. Staff stated medications are provided to residents within 10-15 minutes before and after meals as taken. Staff stated the medication cannot be altered to satisfy the residents’ requests. Changes in medication dosage need to be approved by the residents’ primary physician and/or the pain management physician. Three of four residents stated the staff administers the medications to residents on time and as prescribed. Based on records review and interviews, there is no evidence to corroborate the allegation.

2.Regarding the allegation: Staff did not provide an adequate amount of meals to a resident in care. It is alleged that the facility staff are not providing residents will adequate amount of food in the residents’ meals. Three of three staff deny this allegation. Staff stated each resident is served meals according to resident’s dietary plan, as per physician orders. Staff stated R1 was placed on a 48 -hour liquid diet by physician’s orders after treatment of R1’s health condition. The staff stated R1 argued with staff to provide a solid meal after becoming unsatisfied with the liquid diet ordered by R1’s physician. Three of four residents stated being served adequate food serving with their meals. Based on records review and interviews, there is no evidence to corroborate the allegation.

3. Regarding the allegation: Staff did not complete required training. It is alleged that the facility staff has not completed required training for caregivers and medication technician and are not trained to perform caregiver and medication administration duties. Three of three staff deny this allegation. According to staff records reviewed, the facility staff have all the required training and certificates of completion for their duties performed. Three of four residents could not corroborate the allegation. Residents are not aware of the training required by the facility staff. Based on records reviewed and interviews, there is no evidence to corroborate the allegation.

4.Regarding the allegation: Staff did not prevent medications from being inaccessible to residents in care. It is alleged that facility staff are not locking the medication cabinet and are not preventing medications from being inaccessible to the residents in care. Three of three staff deny this allegation. The staff stated that the medications are locked in a cabinet inside the staff office. The staff allowed to administer medications have access to the medication’s cabinet keys, only. Staff stated the residents are inaccessible to the locked staff office and are inaccessible to the locked medications cabinet. Three of four residents stated not being aware. Based on observations and interviews, there is no evidence to corroborate this allegation.

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

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260128145756

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: 06/16/2026

NARRATIVE

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5.Regarding the allegation: Staff did not maintain a comfortable temperature for residents in care. It is alleged that the facility does not maintain a comfortable temperature for the residents in care and staff are refusing to operate the air-conditioner when residents’ room becomes hot. Three of three staff deny this allegation. S1 stated the air conditioner is kept at a comfortable temperature during the summer and winter months for all residents residing at the facility. Residents experiencing increased temperatures within the residents’ room are provided with a circulating fan to help cool the residents’ room. Three of four residents stated their room temperature is comfortable, and residents were observed having circulating fans in their rooms. Based on observation with State Issued thermometer, LPA Vaid measured temperature in the facility, and each resident rooms and temperature is at 76 deg-78 deg F. Residents were observed comfortably in the facility. Two residents observed with fans on to regulate the temperature to the resident’s preference. Based on observations and interviews, there is no evidence to corroborate the allegation.

6.Regarding the allegation: Staff did not ensure that resident is provided adequate bedding. It is alleged that the staff are not providing residents with adequate bedding, residents’ bedsprings are broken and staff are not replacing the mattress. Three of three staff deny this allegation. S1 stated R1’s home health care agency has been notified of the bedding issue, S1 stated the mattress is intact and springs are not poking through the bedding materials. According to S1’s correspondence with R1’s home-health agency, R1’s health criteria requirements are being evaluated by R1’s home-health agency for bed-overlay / topper on top of a hospital mattress. Staff stated they have provided R1 with a topper mattress for R1’s comfort until R1’s home-health agency can approve R1’s request. Three of four residents could not corroborate this, residents R2-R4 are not aware of this happening. Based on records review and interviews, there is not enough evidence to corroborate this allegation.

Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are unsubstantiated.

Copy of this licensing complaint report was provided to staff Glen Oriemo.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026

LIC9099 (FAS) - (06/04)

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