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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920179
Report Date: 05/28/2026
Date Signed: 05/28/2026 02:53:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2026 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20260407143246

FACILITY NAME:NEW DEVOTION FAMILY CARE HOME LLCFACILITY NUMBER:
315920179
ADMINISTRATOR:BLAS, MEKISHAFACILITY TYPE:
735
ADDRESS:572 SILVER CLOUD CT.TELEPHONE:
(863) 205-4134
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:4CENSUS: 3DATE:
05/28/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Shawnette Etheridge, AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff do not provide adequate amount of food to resident
Staff address resident inappropriately
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA met with administrator Shawnette Etheridge during today’s inspection.
LPA investigated, “Staff address resident inappropriately.” LPA interviewed relevant parties, clients, and staff. Relevant party stated they overheard staff calling C1 inappropriate and derogatory names. LPA interviewed C1 in which they stated staff called them inappropriate names. LPA interviewed staff, in which they stated they have never called C1 inappropriate or derogatory names. Staff report C1 has had escalated behaviors recently and calling staff derogatory names. LPA interviewed 3 other clients in care, and no one reported that staff have called them inappropriate names. Clients reported they have heard C1 calling staff inappropriate names. LPA interviewed regional center, and they have no concerns with the facility at this time. Due to the information gathered, LPA finds allegation to be unsubstantiated.

Continuation on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 59-AS-20260407143246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: NEW DEVOTION FAMILY CARE HOME LLC
FACILITY NUMBER: 315920179
VISIT DATE: 05/28/2026
NARRATIVE
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LPA investigated allegation, “Staff do not provide adequate amount of food to resident”. LPA interviewed relevant parties, clients, and staff and conducted a facility tour. Relevant party stated they have observed that C1 is being served small portions, and there is expired food in the facility refrigerator. LPA interviewed C1 in which they stated staff have been providing them with small portions and C1 reports they are hungry frequently. C1 showed LPA a photo of their breakfast which consisted of 1 sausage patty and small portion of fruit. LPA interviewed 3 additional clients in which they stated they are provided sufficient amount of food and do not go hungry. LPA interviewed care staff in which they stated they provide 3 meals and snacks throughout the day. Staff stated they provide 2nd helpings of foods if clients request it. LPA toured the facility kitchen, and food storage and found 2-day perishable and 7-day non-perishable. Due to the conflicting information, LPA finds allegation to be Unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.



Exit interview was conducted and copy of report provided.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5