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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005554
Report Date: 11/01/2024
Date Signed: 11/01/2024 11:05:22 AM

Document Has Been Signed on 11/01/2024 11:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LLCFACILITY NUMBER:
306005554
ADMINISTRATOR/
DIRECTOR:		KEVIN CLARKFACILITY TYPE:
735
ADDRESS:26665 AVENIDA SHONTOTELEPHONE:
(818) 384-9331
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 4CENSUS: 3DATE:
11/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Laura Palomino- AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Jessica Cho made an unannounced case management visit to follow up on a Accusation (Exclusion Action) received by Community Care Licensing (CCL) on October 16, 2024. LPA was greeted and granted entry by Care Staff Marcie Rechlin. Only one staff and one client was present during today's visit. Administrator (Admin) Laura Palomino arrived shortly after. LPA met with Admin Palomino and explained the reason for the visit.

Admin is aware that Individual #1 (I1) had been served an accusation. LPA was provided with a copy of the received Accusation by the Admin while at the facility. Admin was reminded that I1 is excluded from employment. According to Admin, I1 did not pursue an exemption and was never hired at the facility. LPA reviewed facility personnel records and I1 is not present on any records for employment or termination.

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: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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