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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881116
Report Date: 10/09/2025
Date Signed: 10/09/2025 10:48:09 AM

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
09/30/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250930150930
FACILITY NAME:ELIAA, LLCFACILITY NUMBER:
331881116
ADMINISTRATOR:FACILITY TYPE:
740
ADDRESS:11545 DOVERWOOD DR.,TELEPHONE:
(650) 656-7941
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:6CENSUS: 4DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:House Manager/Licensee Ahmed QasimTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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9
Staff do not ensure resident's hygiene needs are being met.
INVESTIGATION FINDINGS:
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On 10/09/2025 at 9:00 AM Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility in order to initiate and deliver findings for the above allegations. LPA discussed the purpose of the visit with Facility House Manager/Licensee Ahmed Qasim. The investigation consisted of interviews, record review and observation. During the visit there were four residents in the facility and one(1) resident was out in the community.

In regard to the allegation that Staff do not ensure resident's hygiene needs are being met.
LPA interviewed two (2) staff and four (4) residents.Two (2) out of two(2) Staff stated that resident#1 does not like to take showers and staff has tried to assisted the resident#1with shower and change of clothes, but R#1 consistently refuses and R#1 is non complaince with house rules. Staff denied the allegation that staff do not ensure residents's hygiene needs are being met. Residents stated that staff assist them with showering and hygiene needs and Three(3) out of four(4) residents denied the allegation that staff do not ensure residents hygiene needs are being met.

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

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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-20250930150930
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: ELIAA, LLC
FACILITY NUMBER: 331881116
VISIT DATE: 10/09/2025
NARRATIVE
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Based on the evidence found during the investigation, LPA Singh found the allegation: Staff do not ensure resident's hygiene needs are being met listed above to be Unsubstantiated.

Unsubstantiated: A finding that the complaints are Unsubstantiated means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiency were cited during this visit.

An exit interview was conducted, and this report LIC 9099, LIC9099C was discussed and provided to Facility Facility-House Manager/Licensee Ahmed Qasim.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2