<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881241
Report Date: 03/17/2022
Date Signed: 03/17/2022 10:10:01 AM

Document Has Been Signed on 03/17/2022 10:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:FAIRVIEW LIVING LLCFACILITY NUMBER:
361881241
ADMINISTRATOR:NOFAL, YUSEF IZZATFACILITY TYPE:
740
ADDRESS:1089 W HUFF STREETTELEPHONE:
(646) 523-8208
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 10CENSUS: 3DATE:
03/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Yusef Nofal, by phoneTIME COMPLETED:
09:21 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to verify that this facility is vacant and ready for residents. On 3/8/2022 an initial pre-license visit with Administrator (AD) Yusef Nofal was completed however LPA observed clothing and personal items were kept in three of the five bedrooms. Administrator stated these items were AD's family members', who will be leaving the property by 3/15/2022. A second visit was required to verify that the property is vacant as AD stated during the initial pre-licensing inspection.

An unknown female answered the door who stated that their family is occupying this home. LPA asked if AD was available and the female stated they do not know. LPA phoned AD who stated that they are currently out of state and is unable to be present in the facility. AD confirmed a delay in removing AD's family from the home but AD has communicated this concern to their Centralized Application Bureau (CAB) analyst.

Based on today's inspection, the location is currently occupied by a private individual who is not associated to the facility. The facility is not ready for resident occupancy and licensure.

An exit interview was conducted telephonically with AD. A copy of this report was provided via email and a read receipt confirms receipt of the report. AD has agreed to sign the report and return a signed copy to LPA by email.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1