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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209363
Report Date: 10/06/2025
Date Signed: 10/06/2025 02:00:17 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/01/2025 and conducted by Evaluator Mai Yang
COMPLAINT CONTROL NUMBER: 24-AS-20251001095140
FACILITY NAME:DEVOTED HEARTS SENIOR CARE HOME LLCFACILITY NUMBER:
157209363
ADMINISTRATOR:JACKSON, LETICIAFACILITY TYPE:
740
ADDRESS:10311 RIO DEL MAR DRIVETELEPHONE:
(661) 735-7308
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 5DATE:
10/06/2025
UNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Licensee/ Administrator Leticia JacksonTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not allow a resident to use the bathroom.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/06/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct initial complaint investigation on the above allegation. LPA introduced self, stated the purpose of the visit, and met
with Licensee/ Administrator Leticia Jackson. LPA discussed complaint findings with Licensee.

During the course of the investigation, the department conducted interviews, toured the facility, and reviewed
records. Based on interviews conducted, there is insufficient evidences to prove or disapprove that staff did not allow resident to use the bathroom. Therefore, the preponderance of evidence standard
has been met, therefore, the above allegation is found to be UNSUBSTANTIATED. An exit interview
was conducted. A copy of this report was provided to Licensee, whose signature on this
form confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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