306004810-1-22-2026-22-AS-APAO-DQSRN4-20260129120942

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004810
Report Date: 01/22/2026
Date Signed: 01/22/2026 01:20:42 PM

Unfounded

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
01/14/2026 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260114153349

FACILITY NAME:	A FAITHFUL HOME		FACILITY NUMBER:	306004810
ADMINISTRATOR:	THERESA KHOLOMA		FACILITY TYPE:	740
ADDRESS:	26642 SALAMANCA DRIVE		TELEPHONE:	(949) 382-2818
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 6	DATE:	01/22/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Amelia Morales- House Manager #2		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Facility staff is accessing and misusing funds belonging to residents.

INVESTIGATION FINDINGS:

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On January 22, 2026, Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of initiating the complaint investigation into the above allegation. LPA was granted entry after introducing self and explaining the reason for the visit to Caregiver Emely Sarte. LPA was subsequently greeted by House Manager (HM) Amelia Morales. During the course of the investigation, LPA interviewed two staff and six residents, however LPA was unable to qualify three residents due to their medical condition. LPA reviewed records and requested the following copies to be provided via email at end of business day on today's date: Resident Roster, Personnel Report Summary, Face Sheets, Physician's Reports, Admission Agreement, Needs and Services Plans, and bank statements.

The investigation is as follows: Regarding the allegation, Facility staff is accessing and misusing funds belonging to residents, it is alleged that the owner is accessing accounts belonging to Resident #1 (R1) and Resident #2 (R2) by withdrawing repeated charges between $200-$350 for local outings.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

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-20260114153349

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: A FAITHFUL HOME	FACILITY NUMBER: 306004810
	VISIT DATE: 01/22/2026

NARRATIVE

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Based on the interviews, R1 and R2 confirmed that the staff were compensated transportation fees for outings in addition to the recurring monthly rent, which they had no concerns about. R1 and R2 confirmed going out in the community for shopping or appointments with a facility staff who is providing care and transportation for several hours a day also corroborated by two out of two staff. R1 and R2 confirmed withdrawing funds themselves and that staff have not been involved. The remaining resident interviewed denied the allegation. In review of the Admission Agreements dated February 15, 2025 for R1 and February 7, 2025 for R2, R1 and R2 are charged a transportation escort fee in the amount of $40.00 per hour per agreement. Based on the investigation, there are no concerns regarding misusing of funds.

Therefore, this agency has investigated the complaint and based on the interviews which were conducted and the records that were reviewed, the following allegation: Facility staff is accessing and misusing funds belonging to residents is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with House Manager Amelia Morales and Administrator Theresa Kholoma by telephone, and a copy of this report including the LIC811 were provided at exit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

LIC9099 (FAS) - (06/04)

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