306005554-7-22-2026-22-AS-AINZ-DWHUU7-20260731155305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005554
Report Date: 07/22/2026
Date Signed: 07/22/2026 04:25:31 PM

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
07/14/2026 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260714150344

FACILITY NAME:	DEVOTED HEART CARE HOMES LLC		FACILITY NUMBER:	306005554
ADMINISTRATOR:	KEVIN CLARK		FACILITY TYPE:	735
ADDRESS:	26665 AVENIDA SHONTO		TELEPHONE:	(818) 384-9331
CITY:	MISSION VIEJO	STATE:CA	ZIP CODE:	92691
CAPACITY:	4	CENSUS: 3	DATE:	07/22/2026
		UNANNOUNCED	TIME BEGAN:	12:18 PM
MET WITH:	Laura Palomomino- Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff are not disposing or destroying prescription medications from terminated clients.

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 met with Administrator Laura Palomino and stated the reason for the visit. During the course of the investigation, LPA interviewed 3 clients of which LPA was unable to qualify 2 clients due to their medical condition. Additional interviews with 5 staff were conducted. LPA obtained copies of the following documentation for review: Resident/Staff Rosters, Face Sheets, Physician's Reports, Admission Agreements, Individual Program Plans, medication lists, Medication Administration Records (for June and July 2026), physician orders, and Centrally Stored Medication and Destruction Records (LIC622).

Regarding the allegation, Staff are not disposing or destroying prescription medications from terminated clients, it is alleged that old or discontinued medication at the facility was not removed, returned, or destroyed. LPA observed medications belonging to one client is stored in the black locker behind the office desk in the living room.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

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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Control Number 22-AS-20260714150344

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: 07/22/2026

NARRATIVE

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LPA also inspected the locked closet which stores back stock pantry items, hygiene supplies, and other miscellaneous items. LPA observed a plastic bag which contained 22 expired medications. Admin indicated not knowing the medications were there and would be destroyed. LPA verified that medications were documented on the Centrally Stored Medication and Destruction Record (LIC622) form. Per Title 22 regulation, there is not a specific time frame in which medications are destroyed but indicates that medications are destroyed by the facility "upon termination of services or which are not to be retained." Based on three of three staff interviews, none of the staff were aware that the to-be-discarded medications were safeguarded on site. Although expired medications were unknowingly safeguarded on site, such medications were separated and stored in a separate area way from the current routine/PRN medications for one client, and therefore did not pose a risk to the clients in care.

Therefore, based on the observations made, 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 are not disposing or destroying prescription medications from terminated clients 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: 07/22/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

LIC9099 (FAS) - (06/04)

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