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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005554
Report Date: 01/09/2026
Date Signed: 01/28/2026 10:03:49 AM

Unsubstantiated


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:
01/09/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Laura Palomino- AdministratorTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff is denying visitation rights.
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 successfully 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 staff is denying visitation rights.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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: 01/09/2026
NARRATIVE
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The investigation revealed that approximately 7:30am on January 5, 2026, the representative of Client #1 (C1) entered the facility without disclosing their identity or acknowledging staff when they attempted to communicate with the individual and proceeded to inspect the kitchen and take photographs. Based on the interviews of two present staff working on January 5th, it was their first time meeting the individual and was not aware they were C1's representative. After this incident, C1 expressed not having this individual come inside the facility. Based on the review of the IPP dated January 6, 2026, IPP documents that C1 had been informed of their rights in allowing guests to the facility and their room with permission. Prior to this incident, C1's representative had visited in the past based on the sign in/out logs. It is determined that C1's representative had freely visited C1 until C1 expressed discomfort with continuing visits from their representative.

Therefore, although based interviews which were conducted and the records that were reviewed, 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 following allegation: Staff is denying visitation rights is deemed UNSUBSTANTIATED.

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

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6