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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005554
Report Date: 01/28/2026
Date Signed: 01/28/2026 10:01:48 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/07/2026 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260107104724
FACILITY NAME:DEVOTED HEART CARE HOMES LLCFACILITY NUMBER:
306005554
ADMINISTRATOR:KEVIN CLARKFACILITY TYPE:
735
ADDRESS:26665 AVENIDA SHONTOTELEPHONE:
(818) 384-9331
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:4CENSUS: 4DATE:
01/28/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Laura Palomino- AdministratorTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Facility locks food.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of initiating the complaint investigation into the above allegations. LPA was greeted and granted entry by Care Staff Marcie Rechlin after identifying self and explaining the reason for the visit. Administrator (Admin) Laura Palomino arrived on premise approximately 9:30am to assist with the investigation. During the course of the investigation, LPA observed one meal service, inspected the kitchen, garage refrigerators, shared pantry/medication closet, and interviewed two of four clients and four staff. LPA was unable to qualify the remaining two clients due to their medical condition. The following documentation were obtained for review: Client Roster, Personnel Report, Dining Menu, Face Sheets, Physician's Reports, Individual Program Plans (IPPs), Visitor Sign In/Out Logs, and Grocery Receipts.

The investigation is as follows: It is alleged that the facility locks food. Based on LPA's observation, no locking mechanism is present on the primary kitchen fridge. However, the snacks in the medication closet and food supply in the garage refrigerator/freezer remain locked.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
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 22-AS-20260107104724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: DEVOTED HEART CARE HOMES LLC
FACILITY NUMBER: 306005554
VISIT DATE: 01/28/2026
NARRATIVE
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Based on the interviews, one out of four clients and four out of four staff confirmed that the garage refrigerator remain locked due to food related behaviors of two out of four clients which was corroborated on the IPPs. Per Title 22 regulation 80072(a)(3), facility can not interfere with the daily living functions which including eating.

Based on observations and interviews, the preponderance of evidence standard has been met, therefore the allegation, Facility locks food, is deemed SUBSTANTIATED. A deficiency is being cited on the attached LIC9099D.

An exit interview was conducted with Administrator Laura Palomino, and a copy of this report including the appeal rights were provided at exit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260107104724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: DEVOTED HEART CARE HOMES LLC
FACILITY NUMBER: 306005554
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/28/2026
Section Cited
CCR
80072(a)(3)
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80072 Personal RIghts (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(3) To be free from corporal or unusual punishment,… or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating…
This requirement was not met as evidenced by:
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Administrator stated the garage fridge/freezer will remain unlocked and the pantry items in the locked medication closet will be transferred in the kitchen cabinet for client access and proof of photos will be submitted to LPA by POC due date.
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Based on observation and interviews, LPA observed the shared pantry/medication closet and garage fridge/freezer remain locked which was also corroborated by one of four clients and four of four staff which poses a potential Health, Safety, and/or Personal Rights risk to persons 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: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3