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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881247
Report Date: 06/13/2026
Date Signed: 06/13/2026 07:17:05 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/08/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240408142718
FACILITY NAME:COVENANT LOVING CAREFACILITY NUMBER:
331881247
ADMINISTRATOR:BOLADELE IGEFACILITY TYPE:
735
ADDRESS:937 ASTER STREETTELEPHONE:
(213) 820-4701
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY:4CENSUS: 3DATE:
06/13/2026
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Justina Thomas, AdministratorTIME COMPLETED:
05:10 PM
ALLEGATION(S):
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Staff did not accept client back after hospital stay.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit on the allegation listed above. LPA arrived unannounced and met with Administrator, Justina Thomas. The purpose of the visit was explained.

On 4/15/2024, LPA Janette Romero conducted the initial visit and interviews. LPA Chan interviewed 2 Staff and a Client via telephone on 6/12/26. During the visit today, LPA Chan interviewed additional 2 Staff.

Allegation - Staff did not accept the client back after hospital stay. It is alleged that Client #1 (C1) was ready for discharge from the hospital on 4/6/2024. The facility staff did not allow C1 to return due to behavioral issues, violence against staff, and refusal to take medication.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
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 18-AS-20240408142718
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: COVENANT LOVING CARE
FACILITY NUMBER: 331881247
VISIT DATE: 06/13/2026
NARRATIVE
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 LPA Chan interviewed Staff who acknowledged that C1, who was admitted to the facility on 4/2/2024, was aggressive toward staff and was not on medications upon admission. The next day, C1 was placed on a hold by the law enforcement and was taken to the medical center due to physical violence. On 4/6/2024, C1 was ready for discharge, however, the facility did not take client back at that time. Staff stated that they requested for medication support to be provided to help stabilize the behaviors until client could be evaluated by the psychiatrist. The request was denied by the hospital. A Staff acknowledged that the hospital contacted the facility but they did not take client back the same day. Administrator mentioned that their reasons for not accepting the client was due to safety of others at the facility, no psychiatric medication upon discharge, and C1 was not evaluated by the psychiatrist while at the hospital. C1 later returned to the facility on 4/16/2024 and is still residing at this location. Per staff, C1 is doing better but continues to have behavior issues.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 1), are being cited on the attached LIC 9099D.

An exit interview was conducted. The Plan of Correction was reviewed and developed with the Administrator. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240408142718
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: COVENANT LOVING CARE
FACILITY NUMBER: 331881247
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
06/19/2026
Section Cited
CCR
80065(a)
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80065 Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.
This requirement is not met as evidenced by:
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The administrator shall submit a plan to ensure that staff have the emergency intervention training to handle aggressive behaviors. The POC is due by 6/19/26.
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Based on interviews, staff did not accept C1 back to facility on 4/6/24 which posed a potential health and safety, or personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3