331881721-4-15-2026-18-AS-JDHS-DT8N2T-20260417100517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881721
Report Date: 04/15/2026
Date Signed: 04/15/2026 08:52:13 AM

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
03/24/2026 and conducted by Evaluator Armando Perez

COMPLAINT CONTROL NUMBER: 18-AS-20260324161009

FACILITY NAME:	WINTER WOODS COTTAGE LLC		FACILITY NUMBER:	331881721
ADMINISTRATOR:	NOFAL,YUSEF IZZAT		FACILITY TYPE:	740
ADDRESS:	845 W LA CADENA DRIVE		TELEPHONE:	(646) 523-8208
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92501
CAPACITY:	34	CENSUS: 31	DATE:	04/15/2026
		UNANNOUNCED	TIME BEGAN:	08:28 AM
MET WITH:	Facility Manager, Ahmed Salam		TIME COMPLETED:	09:05 AM

ALLEGATION(S):

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Staff did not prevent a resident from hitting another resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Armando Perez, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA Perez met with Facility Manager, Ahmed Salam, and explained both the purpose of the visit and the details of the allegation.

On March 24, 2026, Community Care Licensing Division (CCLD), received a complaint that facility staff did not prevent a resident from hitting another resident in care. It was alleged that facility staff did not provide adequate supervision of Resident #1 (R1), which resulted in an altercation between R1 and R2. Attempts were made to interview Additional Witness 1 (AW1) to gather further information; however, AW1 did not respond to the requests. Interview with Administrator (A1), Yusef Nofal, stated that an altercation did occur. A1 indicated an assessment of R1 was completed to find a compatible roommate. A1 reported that after being placed for three days, R1 was relocated to the room with R2, due to behavioral outbursts. It was assumed that the new room was a better fit, because R2 was frequently out in the community.
Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

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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Control Number 18-AS-20260324161009

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: WINTER WOODS COTTAGE LLC	FACILITY NUMBER: 331881721
	VISIT DATE: 04/15/2026

NARRATIVE

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A1 stated there were no signs of tension or conflict between R1 and R2. Staff 1 (S1) corroborated that an altercation occurred and staff monitored R1 to identify a more suitable accommodation. S1 stated R1 was not aggressive toward others and directed outbursts toward himself. S1 also reported that R1 self-disclosed the physical altercation with R2 and staff followed procedures to address the incident. No further information was obtained on what led to the physical incident between the residents. Interview with R1’s Responsible Party (RP) confirmed being informed by staff about R1’s concerning behaviors. RP emphasized that staff communicated well regarding R1’s concerning behaviors, which ultimately supported the decision to pursue a higher level of care focused on R1’s mental health needs. Information was unable to be obtained from R1 as they declined and R2 was unable to be contacted.

A review of records showed that assessments for R1 were completed, indicating that staff monitoring may be required due to R1’s mental health diagnosis. Additionally, Special Incident Reports, regarding the altercation, were reviewed. The review revealed that staff followed appropriate response procedures, including contacting law enforcement and providing medical assistance to R2.

Based on interviews, observations, and record reviews, the allegation that facility staff did not prevent a resident from hitting another resident in care has been deemed UNSUBSTANTIATED. A finding that the allegation is unsubstantiated, means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted. A copy of this report was provided to Facility Manager, Ahmed Salam.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

LIC9099 (FAS) - (06/04)

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