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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881083
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:28:43 PM

Unfounded


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
02/04/2025 and conducted by Evaluator Raquel Hernandez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250204123750
FACILITY NAME:CATHY'S COTTAGE - ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
331881083
ADMINISTRATOR:BIRKINBINE, JULIEFACILITY TYPE:
740
ADDRESS:4089 INVERNESS DRIVETELEPHONE:
(951) 809-9571
CITY:CORONASTATE: CAZIP CODE:
92883
CAPACITY:6CENSUS: 5DATE:
02/05/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Julie BirkinbineTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Questionable death
Facility staff did not respond to resident's call light
Facility staff did not provide resident's records to responsible person
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to investigate and deliver findings for the above allegatiosn. LPA met with Administrator Julie Birkinbine and explained the reason for the visit.

LPA Hernandez observed complaint was filed underneath the wrong facility address. Allegations listed above did not occur at stated facility.

Based on the evidence gathered, the allegation is deemed UNFOUNDED. A finding that the complaint allegation is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the allegation is dismissed. An exit interview was conducted where this report LIC9099 was discussed and provided to Administrator Julie Birkinbine.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
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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