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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920179
Report Date: 06/30/2026
Date Signed: 06/30/2026 02:00:47 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
05/19/2026 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20260519111314
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: 4DATE:
06/30/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Shawnette EtheridgeTIME COMPLETED:
02:05 PM
ALLEGATION(S):
1
2
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7
8
9
Staff did not ensure client was spoken to in an appropriate manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA spoke licensee Shawnette Etheridge over the phone and met with care staff during today’s inspection.
LPA investigated allegation during complaint # 59-AS-20260407143246. 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 reported at the time C1 had escalated behaviors 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.
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. Copy of report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
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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