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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336408124
Report Date: 05/20/2025
Date Signed: 05/20/2025 12:30:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
10/12/2022 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20221012122212
FACILITY NAME:SHELLEY'S HOUSEFACILITY NUMBER:
336408124
ADMINISTRATOR:AILEEN L. LOPEZFACILITY TYPE:
735
ADDRESS:186 EAST STREETTELEPHONE:
(951) 520-1073
CITY:NORCOSTATE: CAZIP CODE:
92860
CAPACITY:4CENSUS: 3DATE:
05/20/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:House Manager-Marissa OliverosTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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9
Staff yelled at the clients while in care.
Staff became aggressive with the clients while in care
INVESTIGATION FINDINGS:
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9
10
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12
13
Licensing Program Analysts (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct an investigation and deliver findings, Licensing Program Analyst (LPA) arrived at the facility on 5/20/25 at 9:20 AM, LPA identified herself and discussed the purpose of the call with House manager-Marissa Oliveros.

The investigation consisted of interviews with relevant parties and review of pertinent documents.

The first allegation indicates staff yells at residents. LPA interviewed clients and staff. Client #1 (C1) Client #2 (C2), indicated that staff #1 (S1) has never yelled at them. Clients also stated they have never witnessed S1 yell at other clients. Staff #2 (S2) and #3 (S3) states they have never witnessed S1 or other staff yell at the clients.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
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 2
Control Number 56-AS-20221012122212
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SHELLEY'S HOUSE
FACILITY NUMBER: 336408124
VISIT DATE: 05/20/2025
NARRATIVE
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The second allegation indicates staff speaks to residents inappropriately. C1 and C2 stated that S1 nor staff have never spoken to them an inappropriately manner. S1 and S2 stated they have never witnessed S1, or other staff speak inappropriately to clients.

During the investigation, LPA did not find evidence to corroborate the allegations.




Based on the information obtained there is not enough evidence that staff yelled at resident and staff speaks to residents inappropriately. Therefore, the allegations that staff yelled at resident and staff speaks to residents inappropriately are deemed UNSUBSTANTIATED at this time. 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.

An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to House Manager- Marissa Oliveros.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2