198603328-4-20-2026-28-AS-FFIS-DXDVAC-20260828161542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603328
Report Date: 04/20/2026
Date Signed: 04/20/2026 04:30:41 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
04/13/2026 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260413153224

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:	04/20/2026
		UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Glen Oriemo, Lead Caregiver		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff are not administering topical medication as prescribed.
Staff isolates resident.
Staff do not ensure that resident's room is cleaned.
Staff do not ensure that resident has clean linens.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sanjay Vaid conducted a complaint investigation on the allegations listed above. LPA arrived unannounced and met with the Lead caregiver, Glenn Oriemo. The purpose of the visit was explained.

LPA Vaid obtained copies of the resident and staff rosters, toured the facility, and reviewed documents for Resident #1 (R1). Interviews were conducted with Staff #1 - #2 and Residents #1- #4.

The investigation revealed the following:

Allegation: Staff are not administering topical medication as prescribed. It is alleged that the staff are not administer medication to #R1 as prescribed and staff are applying the incorrect medication dosage. R1 stated the doctor did not provide the correct dosage. Two of two staff deny this allegation, staff stated medication is the correct dosage and tropical medication applied to R1 twice daily as prescribed by the physician and staff follow the doctors’ written orders as prescribed. S1 stated they will contact R1’s physician to confirm the medication order as prescribed to R1.
Continued on 9099C.........................

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

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-20260413153224

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: 04/20/2026

NARRATIVE

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Three of four residents could not corroborate this allegation, residents interviewed stated staff provide medications to residents as prescribed by doctors’ written orders. Review of R1’s medication orders state tropical medication to be applied twice daily. Based on records reviewed, interviews with staff, residents and witnesses. 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.

Allegation: Staff isolates resident. It is alleged that the facility staff are isolating resident #R1. Two of two staff deny this; staff stated they interact with all residents during medication time, mealtimes, activities and during assisted daily living services provided. Residents are encouraged to roam the facility grounds freely. LPA Vaid observed R1 able to roam the facility, R1 was observed being able to transfer from bed to wheelchair and can leave the facility unattended. Three of four residents interviewed stated they are not left in isolation by staff, residents stated they interact with the staff daily and are able to freely wander the facility grounds and are not left in isolation. Based on observations and records review, 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.

Allegation: Staff do not ensure that residents’ room is cleaned. It is alleged that the facility staff are not ensuring resident #R1 room is regularly cleaned. Two of two staff deny this allegation, according to the staff the residents’ room is cleaned weekly or as needed. According to R1’s admissions agreement R1’s room is scheduled for housekeeping weekly or as needed. LPA observed staff performing housekeeping during the tour of the facility. LPA Vaid observed the smell of cleaning agent in R1’s room during interview with R1. Three of four residents stated that staff clean their rooms regularly or as needed. One of three witnesses stated visiting the facility daily and that the residents’ room and the facility are kept clean and sanitary. Based on observations, and interview with staff, residents and witnesses, 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.

Continued on 9099C.......................

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20260413153224

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: 04/20/2026

NARRATIVE

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Allegation: Staff do not ensure that resident has clean linens. It is alleged that staff are not ensuring resident #R1 has clean bedding linens. Two of two staff deny this allegation, staff stated residents’ bed linens are changed weekly, sometimes more frequently at residents’ request. S2 stated changing residents’ bed linens weekly or when needed. S2 stated having changed linens for R1 twice last week upon request from R1. LPA Vaid observed extra clean linens available in hallway closet. Three of four residents could not corroborate this allegation, residents stated bed linens are changed weekly and have received extra linen changes due to their personal needs. One of three witnesses stated visiting the facility daily and observed clean linens and bedding provided. LPA Vaid observed clean linen on residents’ bed during tour of the facility. Based on observations and interviews with staff, residents and witnesses, 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.

Exit interview was conducted and copy of licensing complaint report was provided to the facility staff whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

LIC9099 (FAS) - (06/04)

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