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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881239
Report Date: 11/20/2025
Date Signed: 11/20/2025 12:11:43 PM

Unfounded


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
06/04/2025 and conducted by Evaluator Valerie Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250604084712
FACILITY NAME:ELIAA LLC 2FACILITY NUMBER:
331881239
ADMINISTRATOR:YOUNES, AMIRRAFACILITY TYPE:
740
ADDRESS:17520 BROWN STREETTELEPHONE:
(650) 656-7941
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:6CENSUS: 6DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Staff Roger ValenzuelaTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Due to lack of supervision, resident was in a physical altercation with another resident
Staff did not report incident to appropriate agencies
INVESTIGATION FINDINGS:
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On 11/20/2025, Licensing Program Analyst (LPA) Valerie Flores and LPA Armando Perez conducted an unannounced visit to the facility for the purpose of delivering investigative findings into the allegations listed above. LPA Flores met with staff Roger Valenzuela and explained to Roger the purpose of the visit. The investigation consists of interviews, observation, and records review.

Information received alleged that Resident #1 (R1) was in a physical altercation with Resident #2 (R2) due to lack of care and supervision. Interview conducted with R2 reported that an incident did occur between R1 and R2. R2 reports that they were sleeping on the ground when R1 allegedly ran over R2’s leg with a walker. R2 explained they preferred to sleep on the ground as it is more comfortable for them. From there, R2 reports a small physical altercation took place between R1 and R2. Interview with R1 confirmed that an altercation took place but did not want to go into detail of the incident as R1 and R2 made amends.

(Continue to LIC9099C)
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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 18-AS-20250604084712
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: ELIAA LLC 2
FACILITY NUMBER: 331881239
VISIT DATE: 11/20/2025
NARRATIVE
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(Continuation from LIC9099)

R1 reports feeling safe and is okay with sharing a room with R2. Interviews with R1 and R2 confirmed that the incident occurred in the middle of the night and do not believe anyone overheard the altercation. LPA interviewed Resident #3 (R3) who shares a common wall with R1 and R2. R3 reported that they did not overhear any altercation between R1 and R2. Records reviewed reported that Staff #1 (S1) was the only live-in staff onsite during the time of the incident. During a tour of the facility, LPA observed S1’s bedroom to be on the other side of the facility, away from any residents room. Interview with S1 reported that they did not overhear the altercation between R1 and R2. S1 further reported that staff are required to check on the residents (3) three times during the night. S1 reported doing their nightly rounds and did not observe anything out of the ordinary. The facility does not maintain a log of when nightly rounds are conducted. Records review conducted of R1 and R2’s needs and service plans do not address neither residents requiring 1:1 supervision. Records reviewed of the facility’s plan of operation do not report having wake staff during the nocturnal hours but do have live-in staff at the facility.
Information received alleged staff did not report incident to Community Care Licensing. Interview with S1 and R1 corroborated that the physical altercation between Resident #1 (R1) and Resident #2 (R2) was reported to S1 the following morning. Interview with S1 reported that they called Staff #2 (S2) to inform S2 of what R1 divulged to S1. S2 instructed S1 to ask R1 if they would like to file a police report to which R1 declined. Interviews with S2 confirmed S1’s account of the telephone call taken place. Interviews conducted with S1 and R1 confirmed that R1 refused to file a police report. A records review conducted of the facility’s incident reports received at Community Care Licensing confirmed an incident report was received on 6/4/2025 detailing an altercation between R1 and R2. The incident took place on 5/31/2025. Per Title 22, Reporting Requirements, the facility has within 7 days to report an incident which threatens the welfare, safety or health of any resident, caused by staff or by other residents.
Therefore, the allegation of due to lack of supervision, resident was in a physical altercation with another resident and staff did not report incident to appropriate agencies has been deemed unfounded. A finding that the allegation is unfounded meaning that the allegation was false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided to staff, Roger Valenzuela.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2