361881241-5-21-2025-56-AS-NBRN-DN72VW-20251106164438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881241
Report Date: 05/21/2025
Date Signed: 05/21/2025 12:23:54 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
05/20/2025 and conducted by Evaluator Lavette Farlow

COMPLAINT CONTROL NUMBER: 56-AS-20250520152929

FACILITY NAME:	FAIRVIEW LIVING LLC		FACILITY NUMBER:	361881241
ADMINISTRATOR:	ABDALLATEF, AHMAD		FACILITY TYPE:	740
ADDRESS:	1089 W HUFF STREET		TELEPHONE:	(909) 805-5025
CITY:	RIALTO	STATE: CA	ZIP CODE:	92376
CAPACITY:	10	CENSUS: 7	DATE:	05/21/2025
		UNANNOUNCED	TIME BEGAN:	10:49 AM
MET WITH:			TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Staff do not provide adequate food service
Staff have inadequate record keeping for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) LaVette Farlow conducted an unannounced visit to the facility to investigation a complaint of the of above mentioned allegations. LPA met with House Manager Guadalupe Leon who provided a tour of facility and called the Licensee and informed him of the reason for today's visit. The investigation consisted of interviews with staff, residents, and review of records.

Allegation 1: Staff do not provide adequate food service. LPA interviewed 3 out of 3 resident and they stated the food was good or okay and they have plenty of food in the refrigator and pantry. 3 out of 3 resident stated they have not send a shortage of food. LPA interviewed three (3) staff and 3 out of 3 staff stated we always have plenty of food for residents in care. S1 stated if any thing food may go bad because we have too much. At 9:15AM, LPA observed during the tour of the facility that the pantry had a sufficient amount of can goods and non-perishable item for the number of residents in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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-20250520152929

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: FAIRVIEW LIVING LLC	FACILITY NUMBER: 361881241
	VISIT DATE: 05/21/2025

NARRATIVE

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LPA also, observed a sufficient amount perishable item in the kitchen, refrigerator and freezer for the number of residents in care. LPA observed the facility has no expired perishable and nonperishable items in facility. The facility has sufficient food supply in the refrigerator, pantry, and storage for the residents in care for 7 days of nonperishable and 2 days of perishable items. Also, the facility maintains a weekly meal menu posted for residents., Based on LPA interviews and observation during the visit and tour the allegation is UNSUBSTANTIATED.

Allegation 2: Staff have inadequate record keeping for resident. LPA reviewed five (5) out of five (5) residents files. LPA review of residents file revealed that the facility maintained 5 out 5 residents files with the LIC602, Admission agreement, Identification and contact sheet, and centrally stored medication log. Based on the findings the allegation is UNSUBSTANTIATED.

Based on the information above, the allegations is unsubstantiated. A finding of UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted where this report LIC 9099 and LIC 9099C was discussed and a copy was provided to the House Manager Guadalupe Leon.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC9099 (FAS) - (06/04)

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