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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881241
Report Date: 09/03/2025
Date Signed: 09/03/2025 02:07:31 PM

Substantiated


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
08/26/2025 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20250826085701
FACILITY NAME:FAIRVIEW LIVING LLCFACILITY NUMBER:
361881241
ADMINISTRATOR:ABDALLATEF, AHMADFACILITY TYPE:
740
ADDRESS:1089 W HUFF STREETTELEPHONE:
(909) 805-5025
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:10CENSUS: 9DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ahmad Abdallatef, Administrator TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Unqualified staff members are allowed to provide care and supervision to residents in care
INVESTIGATION FINDINGS:
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On September 3, 2025, at approximately 8:15 AM, Licensing Program Analyst (LPA) LaVette Farlow conducted an unannounced visit to the facility to deliver findings on the above-mentioned allegations. LPA was greeted and granted entry into the facility by R1. LPA requested to speak with staff and R1 stated staff is coming. R1 contacted Licensee, Yusef Nofal. Licensee informed LPA Farlow that the Administrator will be arriving soon. LPA Farlow informed Yousef the reason for the visit .

The investigation consisted of interviews with staff, residents, and review of records.

The allegation is Unqualified staff members are allowed to provide care and supervision to residents in care. LPA Farlow was greeted and granted in the facility by R1. LPA Farlow was informed by R1 and Licensee that staff was not present and on their way to the facility. LPA did not observe any staff at the time of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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 3
Control Number 56-AS-20250826085701
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: 09/03/2025
NARRATIVE
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LPA Farlow observed R1 washing dishes. Interviews with staff and residents revealed that staff is not present from approximately 7:30 AM to 8:30 AM. Interviews also revealed that R1 is acting in a staff role by prepare meals, cleaning up, doing laundry, and dispensing medication. Based on interviews and observations, the allegation is substantiated.

Based on observations, interviews, and records review, the allegations are SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegations are valid because the preponderance of the evidence standard has been met. During today’s visit, a deficiency was cited and an exit interview was conducted, and this report LIC9099, LIC9099C, LIC9099D and appeal rights were discussed and provided to Adminsitrator, Ahmad Abdallatef.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20250826085701
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/03/2025
Section Cited
CCR
87355(e)(1)
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87355(e)(1) Criminal Record Clearance
(e) All individuals subject to a criminal record... volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement is not met as evidenced by:
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Administrator stated that he will hiring more staff and remove (R1) from participating in capacity of a staff and submit signed Statement of Understanding on CCR 87355(e)(1) to LPA by POC due date.
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Based on observation, interview and record review, the administrator did not comply with the section cited above in requesting a criminal record clearance for (R1) which poses an immediate health, safety and personnal rights risk to persons in care.
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Type B
09/10/2025
Section Cited
CCR
87412(a)
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87412(a) Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:
This requirement is not met as evidenced by:
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Administrator stated that he will be updating and completing the staff's records by POC due date. Administrator stated that he will submit signed Statement of Understanding on CCR 87412(a) to LPA by POC due date.
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Based on observation, interview, and record review, the Administrator did not comply with the section cited above by not ensuring personnel records and endangering 9 out of 9 residents which poses a potential health, safety and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3