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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603491
Report Date: 05/14/2026
Date Signed: 05/14/2026 05:28:03 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
05/13/2026 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260513100515
FACILITY NAME:COVENANT CARE HOMEFACILITY NUMBER:
198603491
ADMINISTRATOR:BUNDI ERICK NYAGAFACILITY TYPE:
735
ADDRESS:2027 SHAMWOOD STTELEPHONE:
(562) 500-0715
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:4CENSUS: 4DATE:
05/14/2026
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Bundi Nyaga - AdministratorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff did not obtain medical care for resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced initial complaint visit regarding the above mentioned allegation. LPA met with Bundi Nyaga, administrator and explained the reason for the visit.

The investigation consisted of the following: LPA obtained a copy of the staff & client rosters, Staff schedule, Shift notes, Unusual Incident/Injury reports (SIRs) (Jan-May 2026), Client #1 (C1) - Client #4 (C4) files such as Identification and Emergency Information (Face sheet), latest IPP, Medication administration record (MAR) for Apr 2026 and other relevant documents pertaining to the investigation. LPA interviewed Staff #1 (S1) - Staff #2 (S2) and Client #1 (C1). LPA called the Service Coordinator (SC) at San Gabriel Pomona Regional Center 3x (@1:45pm, 2:42pm and 3:30pm), but no response received. LPA attempted to interview Client #2 (C2) - Client #4 (C4) but unsuccessful due to their cognitive abilities. *****CONTINUED ON LIC9099-C*****
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
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 2
Control Number 28-AS-20260513100515
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: COVENANT CARE HOME
FACILITY NUMBER: 198603491
VISIT DATE: 05/14/2026
NARRATIVE
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The investigation revealed the following:

Allegation: Staff did not obtain medical care for resident. It is alleged that clients are not being cared for, and that a client fell with a scratch and was not seen by the nurse. Staff interviewed denied the allegation stating that any client who falls is evaluated and taken to the emergency room or urgent care if needed. Staff also stated there have been no fall incidents involving clients. S1 indicated that they have a protocol in place for falls and injuries, whereby staff notify the administrator, conduct body checks and document assessments. S1 also noted that falls require notifying the physician and family. Client interviewed stated they have not fallen or suffered any scratches, nor have they seen any other clients fall and sustained an injury. LPA reviewed documents and found no incident reports (SIRs) of falls or injuries between January 2026 and the present. The shift notes were also reviewed, and there was no mention of a fall or of clients sustaining minor injuries. LPA attempted to contact SC at San Gabriel Pomona Regional Center but received no response. During the visit, the facility was observed to be safe and clean, with no signs of neglect. Also, LPA did not observe scratches/bruises or any signs of neglect on any of the clients. Therefore, there is insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with client and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation.



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 conducted and a copy of this report was provided to Bundi Nyaga, Administrator.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC9099 (FAS) - (06/04)
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