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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603366
Report Date: 06/02/2026
Date Signed: 06/02/2026 03:41:22 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
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 Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260407090059
FACILITY NAME:SHILOH RETREATFACILITY NUMBER:
198603366
ADMINISTRATOR:QUEZADA, JESSEFACILITY TYPE:
740
ADDRESS:9956 SHILOH AVETELEPHONE:
(562) 755-7464
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:6CENSUS: 6DATE:
06/02/2026
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Amalia Ramos, StaffTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Due to lack of supervision, resident eloped from the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver findings for the allegation(s) listed above. LPA met with Staff Amalia Ramos and explained the purpose of the visit.

On 4/14/26, LPA Chan conducted the initial visit. LPA obtained copies of the staff and resident rosters, documents for Resident #1, and interviewed four (4) staff and five (5) residents. During the visit today, LPA interviewed another staff.

The investigation revealed the following:
Allegation – Due to a lack of supervision, resident eloped from the facility. LPA interviewed the staff regarding this allegation. The administrator acknowledged that on 4/4/26, Resident #1 (R1) exited the facility independently without staff knowledge or supervision. Staff was assisting another resident when R1 left the facility. Staff heard the alarm on the door and went to check on R1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 28-AS-20260407090059
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SHILOH RETREAT
FACILITY NUMBER: 198603366
VISIT DATE: 06/02/2026
NARRATIVE
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Staff saw R1 walking up the block but could not go after R1 because staff was assisting another resident in the showers. R1 ended up at another facility that was close by and was unharmed. LPA review R1's physician's report, which indicated that R1 cannot leave the facility unassisted.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 8), are being cited on the attached LIC 9099D.

An exit interview was conducted. A copy of this report and appeal rights were provided to staff Ramos.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20260407090059
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SHILOH RETREAT
FACILITY NUMBER: 198603366
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements – General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...
This requirement is not met as evidenced by:
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Licensee shall conduct an in-service training to ensure staff are providing supervision to residents.

***The inservice log was received during the visit today. POC will be cleared.
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Based on interviews and record review, R1 left the facility unassisted which poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
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 Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260407090059

FACILITY NAME:SHILOH RETREATFACILITY NUMBER:
198603366
ADMINISTRATOR:QUEZADA, JESSEFACILITY TYPE:
740
ADDRESS:9956 SHILOH AVETELEPHONE:
(562) 755-7464
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:6CENSUS: 6DATE:
06/02/2026
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Amalia Ramos, StaffTIME COMPLETED:
03:50 PM
ALLEGATION(S):
1
2
3
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9
Staff did not intervene during a resident on resident physical altercation resulting in injury.
Staff turned off the alarms on the doors resulting in resident eloping.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver findings for the allegation(s) listed above. LPA met with Staff Amalia Ramos and explained the purpose of the visit.

On 4/14/26, LPA Chan conducted the initial visit. LPA obtained copies of the staff and resident rosters, documents for Resident #1, and interviewed four (4) staff and five (5) residents. During the visit today, LPA interviewed another staff.

The investigation revealed the following:
Allegation - Staff did not intervene during a resident on resident physical altercation resulting in injury. Staff interviewed stated that they are always supervising the residents. When residents engage in altercations, they immediately intervene to prevent anyone from getting injured. Staff stated that they are aware of Resident #1 (R1) having physical and verbal aggression and are monitoring R1 more carefully.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20260407090059
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SHILOH RETREAT
FACILITY NUMBER: 198603366
VISIT DATE: 06/02/2026
NARRATIVE
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LPA received and reviewed the incident report that was sent to licensing regarding R1 attacking R2 and ripping off two of R2’s nails. Staff on duty immediately intervened and separated the 2 residents. Staff acknowledged that R1 has been displaying more physical aggression lately. R1 had been seen by the behaviorist and physician regarding the recurring behaviors. LPA interviewed five (5) residents. Residents stated that the staff are always supervising them and will intervene right away when residents become aggressive.

Allegation - Staff turned off the alarms on the doors, resulting in resident eloping. Staff interviewed denied turning off the alarms on the doors. Staff stated that when Resident #1 eloped from the facility, staff heard the alarm, which alerted staff to check on the resident. During the visit on 4/14/26, LPA checked the exit doors. The doors will sound loudly when they are open. Staff stated there is a switch to turn off the sound, but they always keep it on for extra security. LPA interviewed five (5) residents, and they all stated that the alarm will sound when someone opens the door. Staff do not turn off the alarm on the doors.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are UNSUBSTANTIATED.



An exit interview was conducted with Staff Ramos. A copy of this report, along with the appeal rights, was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5