331881257-5-29-2026-18-AS-RORN-DUNQWK-20260602123206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881257
Report Date: 05/29/2026
Date Signed: 05/29/2026 01:51:36 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/12/2024 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 18-AS-20240712110432

FACILITY NAME:	OSLO HOME		FACILITY NUMBER:	331881257
ADMINISTRATOR:	CLOYD, SHILOH		FACILITY TYPE:	735
ADDRESS:	3678 OSLO CT		TELEPHONE:	(619) 292-9299
CITY:	HEMET	STATE: CA	ZIP CODE:	92545
CAPACITY:	4	CENSUS: 1	DATE:	05/29/2026
		UNANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	Ana Gonzalez		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff speaks to resident in an inappropriate manner.

INVESTIGATION FINDINGS:

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On May 29, 2026, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegation and to deliver findings. The Department was met by Ana Gonzalez and reason for visit explained
The facility currently has 1 client in placement and 1 staff available at time of visit.
Investigation consisted of the following:
On August 7, 2024, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above. During the visit, it was determined that the complaint required further investigation.
On May 28, 2026, the department conducted an unannounced visit to continue investigation of above allegations. The department obtained the following documentation: Staff roster (dated 8/7/24), Staff training sign in sheet on clients rights (5/1/24, 5/8/23, 5/7/23), C1signed client's right document (dated 9/16/26), Reviewed client files (C1 and C2) Admission Agreement (dated 9/16/23) C1’s IPP (dated: 3/3/25), Behavioral Assessment (dated: 10/14/25) and C1”s Physician’s report (11/21/2024)
On May 28, 2026, the department conducted 1 staff interview (S1), 1 client interview (C2) reviewed 2 client charts. During that visit it was determined that further investigation is need to conduct more interviews.
On May 29, 2026 The department interviewed Administrator (A1) via telephone.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

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 3

Control Number 18-AS-20240712110432

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OSLO HOME	FACILITY NUMBER: 331881257
	VISIT DATE: 05/29/2026

NARRATIVE

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The investigation revealed the following

Allegation: Staff speaks to resident in an inappropriate manner.

The complaint alleges that staff have referred to C1 as “retarded” on several occasions during his behavioral outbursts.

On May 28, 2026, the Department interviewed one staff member (S1), who denied the allegation. S1 stated she has never spoken to C1 in an inappropriate manner and has not witnessed any other staff doing so. She also reported that all staff receive client rights training, which is updated annually.

On May 28, 2026, the Department also interviewed one client (C2), as C1 moved out of the facility in February 2026. C2 reported that staff have never spoken to her in an inappropriate manner. C1 stated she has never been called “retarded,” nor has she heard staff use that term toward any client. C2 expressed that she feels safe and well cared for in the home.

On May 28, 2026, the Department reviewed the following documentation: staff training sign-in sheets for client rights training (dated 5/1/24, 5/8/23, 5/7/23), signed client rights forms (dated 9/16/23), client files for C1 and C2, the Admission Agreement (dated 9/16/23), C1’s IPP (dated 3/3/25), Behavioral Assessment (dated 10/14/25), and C1’s Physician’s Report (dated 11/21/2024).

On May 28, 2026, the Department observed that the facility was clean, safe, and sanitary.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20240712110432

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OSLO HOME	FACILITY NUMBER: 331881257
	VISIT DATE: 05/29/2026

NARRATIVE

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On May 29, 2026, via telephone, the Department interviewed the Administrator (A1), who denied the allegation, stating that there have been no reports of staff speaking inappropriately to C1. A1 also confirmed that staff receive annual client rights training.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Ana Gonzalez. No deficiencies cited during today’s visit. Copy of report provided.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3