<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603328
Report Date: 10/28/2024
Date Signed: 10/28/2024 11:54:14 AM

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
10/24/2024 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241024085450
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:
10/28/2024
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Glenn Oriemo, Lead CaregiverTIME COMPLETED:
12:03 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not allow resident visiting at the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA Alberto Lopez conducted an unannounced complaint investigation for the allegation listed above. LPA met with Glenn Oriemo, Lead Caregiver. LPA explained the purpose of today's complaint investigation visit.

The investigation consisted of the following: LPA obtained staff roster, resident roster, visiting log for 10/2024, Facility Visiting Policy, DSS clearance for W1, interviewed four (4) residents ((R#1-R#4), One (1) resident was sleeping, three (3) staff (S#1-S#3), and interviewed two (2) Witness (W#1-W#2), and conducted a tour of physical plant.

The investigation revealed: Regarding allegation: Staff did not allow resident visiting at the facility. It is alleged that W2 arrived at the facility to visit on 10/23/2024 and was not allowed entry into the facility. LPA interviewed three (3) staff and all three (3) denied the allegation. S1 stated that W2 has never been refused entry to facility. (Continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024
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-20241024085450
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: 10/28/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(continued from 9099)

LPA reviewed visitor sign in log for the month of 10/2024 and it showed that W2 made visit on 10/08/2024, 10/11/2024, 10/16/2024, 10/18/2024, 10/22/2024, and 10/25/2024. There is no evidence that W2 was refused entry on 10/23/2024. S1 denied that facility denied entry to W2 on 10/23/2024. S1 stated that W2 did not show up at facility on 10/23/2024. LPA interviewed four (4) residents and four (4) of four (4) could not corroborate the allegation. All four residents interviewed stated that they are allowed to have visitors.

Based on the information obtained during the investigation, interviews with staff, and residents, the investigation did not reveal any evidence to support the allegation mentioned above.

Although the allegation may have happened or is 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 Glenn Oriemo, Lead caregiver, and findings were discussed. A copy this report was provided at the time of visit.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2