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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425840
Report Date: 06/09/2025
Date Signed: 06/09/2025 03:12:27 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
06/09/2025 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20250609020226
FACILITY NAME:COTTAGES AT RIVERSIDEFACILITY NUMBER:
336425840
ADMINISTRATOR:TAWFIK, EVAFACILITY TYPE:
740
ADDRESS:6280 CLAY STREETTELEPHONE:
(951) 360-1616
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:110CENSUS: 83DATE:
06/09/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Eva Tawfik, Executive DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Unqualified staff are administering medications to the residents
Staff are not providing adequate care and supervision of the residents
INVESTIGATION FINDINGS:
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On 6/09/2025 at 12:00 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Serrano explained the purpose of the visit to Executive Director Eva Tawfik. The investigation consisted of file review, interviews with staffs and residents as well as observation.

Allegation #1 Unqualified staff are administering medications to the residents – Based on residents and staff interview, 7 out of 7 residents and 4 out of 4 staff stated that the staff are qualified to administer their medication. Residents stated they have no reason to believe that the staff are not qualified. LPA reviewed files and observed that all Medtech’s that work at the facility have their training and certificate to administer medication.

Allegation #2 Staff are not providing adequate care and supervision of the residents - Based on resident’s interview, 7 out of 7 residents and 4 out of 4 staff stated that the facility has staff that provides adequate care and supervision. Every resident interviewed stated that they are taken care of.
*** Continuation in LIC9099C ***

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
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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Control Number 56-AS-20250609020226
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: COTTAGES AT RIVERSIDE
FACILITY NUMBER: 336425840
VISIT DATE: 06/09/2025
NARRATIVE
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During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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 at this time.

An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Executive Director Eva Tawfik.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC9099 (FAS) - (06/04)
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