Fairview Living 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Beena Singh arrived at the facility unannounced to conduct a required Annual visit. LPA was greeted by Yusef Izzat Nofal, Facility Administrator. LPA toured the facility inside and outside. LPA observed that there are currently no residents living/admitted to the facility, waiting for Assisted Living Waiver from the department. Facility is a two storey house with four (4) bedrooms, one staff bedroom/bathroom, two (2) resident bathrooms, living room, dining area and kitchen. There was an attached two car garage on the right side of the house. LPA toured the interior and exterior areas of the facility. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a 78 degrees Fahrenheit temperature. LPA inspected residents bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected residents bathrooms; bathrooms were clean and appliances were operating appropriately. LPA tested the water temperature in the bathroom faucet, which tested within regulation at 107 degrees Fahrenheit. The facility is equipped with operating fire extinguisher, smoke detectors and carbon monoxide alarms. There was a designated locked storage space for resident/staff files, first aid kit and medication. The facility had emergency supplies for future clients. There are no pools, bodies of water, firearms or ammunition. Overall, the facility is clean, in good repair, and operating in safe conditions for future residents in care. Yards/Outdoors: There is sufficient covered seating area the backyard. The gate on the right side is the exit and is self-latching. There is a storage/staff unit in the backyard. All outdoor pathways were free of obstructions. Food Service: Non-perishable and perishable food supply is sufficient for future clients in care. Dishes, cups, and utensils were also stored properly. Emergency food and water were also observed. Record Review: No records to review due to no residents in the facility and no staff working in the facility. No deficiencies were cited during today's visit. An exit interview was conducted where this report LIC809, LIC809C were discussed and copies were provided to Yusef Izzat Nofal, Facility Administrator.the state’s words, verbatim · CDSS document, Jul 3, 2026

Type of visit: Prelicensing

On 06/30/2025 at 9:00 AM Licensing Program Analyst (LPA) Beena Singh conducted an announced applicant initiated visit to the facility for the purpose of a Pre-Licensing evaluation. LPA Singh met with Administrator Yusef Izzat Nofal. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 05/01/2024 for a total capacity of six (6) ambulatory residents. Fire clearance was granted on 03/04/2025. LPA observed the following: Structure: Facility is a two storey house with four (4) bedrooms, one staff bedroom/bathroom, two (2) resident bathrooms, living room, dining area and kitchen. There was an attached two car garage on the left side of the house. Heating /Cooling System: Central heating and air conditioning system installed with a control panel located in the garage of the facility. Bedrooms: All bedrooms will accommodate ambulatory residents and are adequately furnished with bed, closet, appropriate linens and adequate lighting. Night lights were observed in the facility and will be placed in the hallways leading to residents' shared bathrooms. Bathrooms: There is a staff bedroom with bathroom and there are two (2) bathrooms for the residents which have working toilets, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. The water temperature was measured at 110 degrees Fahrenheit in the resident’s bathroom. Kitchen: The kitchen has adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp and hygiene care items were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. There was sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry: Laundry room with washer and dryer was upstairs. Laundry detergents and cleaning supplies will be locked in the laundry room and laundry room can be locked from exterior door. Living /Family Room: There was a living/family room with a TV and adequate seating for all residents. Residents Activities, pool table and furniture will be placed in the living area for the residents. Linens and Hygiene: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outdoors: There is sufficient covered seating area the backyard. The gate on the right side is the exit and is self-latching. There is a storage/staff unit in the backyard. All outdoor pathways were free of obstructions. Emergency Phone Numbers and Exit Plan: Facility sketches were observed posted in the main living room area. There was one (1) fire extinguisher downstairs near kitchen area and one(1) upstairs in the hallway, and four (4) carbon monoxide detectors and five (5) smoke detectors which are working and in good condition. General items: Client records will be stored in a locked cabinet in the kitchen area. First Aid kit with required components is located in the dining room cabinet. Personnel files and medication will be locked in the cabinet next to the television sitting area. LPA observed a facility phone-909-365-0666 and it was verified to be operational. Emergency water supply and food were observed. The facility has met the requirements according to Title 22 regulations and is ready for licensor. An exit interview was conducted, no deficiencies were cited, Component III was completed during this visit, and a copy of this report was reviewed and provided to Administrator Yusef Izzat Nofal.the state’s words, verbatim · CDSS document, Jun 30, 2025

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Yusef Nofal, Administrator/Applicant Interview Method: Virtual interview (Microsoft Teams) On May 16, 2025, Applicant/Administrator participated in COMP II. Identification of the Applicant/Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility Operation: License Type, Client/Resident Populations, and Program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readinessthe state’s words, verbatim · CDSS document, May 16, 2025