Fountain of Youth Senior Living 2

Type of visit: Prelicensing

On November 7, 2025 at 3:00pm, Licensing Program Analyst (LPA) Eboni Bentley conducted an announced subsequent Pre-Licensing continuation visit. LPA and LPM were allowed entry and met with Applicant Moe Jerrar. The purpose of today's visit was to follow-up on the issues that were present during the initial Pre-Licensing visit on October 9, 2025 and October 24, 2025. During the today's visit, the following issues below have been corrected: · Bed rails have been removed · Inside and outside of physical plant has been cleaned and is sanitary and in good repair · Admission agreement posted · Emergency Disaster Plan (LIC610E) updated and emergency supplies available · LIC610E amended to reflect the type of residents served (non-ambulatory, bedridden) · Outdoor covered seating area with umbrella provided · Sprinkler system leak repaired · Dry brush and debris around exterior of physical plant removed · Rack over toilet in resident bathroom removed · Stone hazard in the backyard walkway removed and leveled · Doorbell replaced and loud sound eliminated CONTINUE TO LIC809-C..... During today's inspection, following the items reviewed during the visit are not in compliance: · Remove hospital beds and replace with beds approved for residents use · Clean outdoor pool/body of water Due to the below pending issues, pre-licensing cannot be approved today. Based on today’s observations, the facility is not ready for licensure. A subsequent video teleconference call will be conducted with LPA to review the corrections on November 10, 2025 and Applicant will contact the department if an extension is needed. An exit interview was conducted with Applicant Moe Jerrar, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Nov 7, 2025

Type of visit: Prelicensing

On October 24, 2025, Licensing Program Analyst (LPA) Eboni Bentley and Licensing Program Manager (LPM) Lourdes Montoya conducted an announced subsequent Pre-Licensing continuation visit. LPA and LPM were allowed entry and met with Applicant Moe Jerrar. The purpose of today's visit was to follow-up on the issues that were present during the initial Pre-Licensing visit on October 9, 2025. During the today's visit, the following issues below have been corrected: · Clear passageways in the garage. Store water hoses on respective racks. · Install grab bars in resident bathrooms · Ensure that the home/residents' bedroom spaces and garage are de-cluttered and ready for use · Regulate water temperatures in all bathrooms to measure between 105 and 120 degrees Fahrenheit. · Adequately stock emergency water supplies · Ensure ADU is occupied by facility staff only and person(s) are associated with facility · Missing postings- Ombudsman poster, Visitor hours and policy, and Food menu. · Submit proof of liability insurance policy. CONTINUE TO LIC809-C..... During today's inspection, following the items reviewed during the visit are not in compliance: · Remove hospital bed and rails and replace with bed approved for residents use · Deep clean inside and outside of physical plant to ensure facility is sanitary and in good repair · Missing postings- Admission agreement. · Ensure all emergency supplies which include but are not limited to such as large & small flashlight, propane/gas lanterns with back up propane, small portable stove, whistle/bell, charger, and cooler are obtained per the Emergency Disaster Plan (LIC610E) · Amend the LIC610E reflecting the type of residents served (non-ambulatory, bedridden) · Provide an umbrella for outdoor covered seating area · Repair leaking sprinkler system for landscape · Remove dead and dry brush and debris around exterior of physical plant · Clean outdoor pool/body of water · Remove rack over toilet in resident bathroom · Repair, remove, level stone hazard in the backyard walkway · Repair doorbell to remove loud sound Due to the below pending issues, pre-licensing cannot be approved at this time. Based on today’s observation, the facility is not ready for licensure. A subsequent visit will be conducted to review the corrections on November 4, 2025 and Applicant will contact the department if an extension is needed. An exit interview was conducted with Applicant Moe Jerrar, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Oct 24, 2025

Type of visit: Prelicensing

On October 9, 2025 at 8:00am, Licensing Program Analyst (LPA) Eboni Bentley arrived announced for the purpose of conducting the Pre-Licensing visit for an Initial Application. LPA conducted the visit with Applicants/LLC Members Suha Abdalla and Moe Jerrar. The initial application to operate a Residential Care Facility for the Elderly (RCFE) was received by the Department of Social Services on January 28, 2025 for age range 60 and over. LPA toured the facility's indoor and outdoor physical plant with Applicants Abdalla and Jerrar. The following were observed: Structure: The facility is a single-story property in a residential neighborhood comprised of five resident bedrooms, three full bathroom, and staff/caregiver bedroom located in an ADU in the backyard. There is also a gated pool in the backyard. Currently, the ADU is occupied by a tenant not associated to the facility. All bedrooms inside the main building will be for resident use. LPA observed all common areas which include the living room, dining area, kitchen, and an unattached two car garage. Telephone Number: Facility land line number (714) 941-9690 was tested and remains available. CONTINUE TO LIC809-C .... Emergency Phone Numbers/Exit Plan: Posted on the bulletin board. Postings: The See Something, Say Something (PUB475) was in the correct size and posted at the entry way. Rights of the Resident Councils, Resident's Rights, Theft & Loss Policy, Activity Schedule, and Administrator Certificates were also posted. The Ombudsman Poster, Food Menu, a copy of the Admissions Agreement, and Visitor hours and policy were missing. Food Service and Menu: A sufficient amount of emergency food was observed. The facility does not have a seven-day supply of non-perishable, two-day perishables, and emergency water available. Smoke and Carbon Monoxide Detectors: The smoke detectors and carbon monoxide alert systems were tested and found operational. Fire Extinguishers: A fire extinguisher was mounted, fully charged, and purchased on February 13, 2025. Fire Clearance: Approved on August 11, 2025 for 6 residents of which, 2 are ambulatory, 3 non-ambulatory, and resident may be bedridden. Signal System: There is a signal system is connected to exit door alarms throughout the facility. Reading Material, Games, Equipment, & Materials: Games and activities will be stored in the living room area. CONTINUE TO LIC809-C .... Bedrooms: Residents’ bedrooms had all required furniture, are spacious, and easily accommodate the residents’ belongings. Four out of five bedrooms contained hospital beds of which one had a full rail and two had ½ rails installed. Three or more beds were missing the following items: Bedspreads, top sheets, bottom sheets, pillow cases, and mattress pads, Per Applicant, Resident Bedroom #3 contained personal belongings from applicant’s previous tenant and will be removed and ready for resident use. Personal belongings were observed in closet and drawers. Bathrooms: All three bathrooms were operational with slip resistant mats in place. Grab bars were present in one out of three bathrooms. All bathrooms were missing bath towels, wash clothes, and hand towels. Water Temperature: The water temperature in three bathrooms measured at 127.2, 128.4, and 131.9 degrees Fahrenheit. Linens and Hygiene Supplies: Clean linens were not adequately stocked and no hygiene supplies for resident use were observed. Appliances: Stove burners, microwaves, refrigerator, freezer, and washer/dryer were inspected and operating. LPA observed damage to outer covering of microwave and applicant stated intentions to replace the microwave with a new one. Resident and Staff Files: Resident and staff records will be maintained on site. Medication: Medication will be secured in a file cabinet in the kitchen. CONTINUE TO LIC809-C .... Sharps and Toxins: Sharps were observed to be secured and inaccessible. Cleaning supplies and toxins were observed in a locked cabinet under kitchen sink. First Aid Kit, & Manual: The First Aid Kit and manual were checked and found to be in order. Backyard There are two sheds in the backyard that will be used for storage. Garage The garage is being used for storage with a significant amount of clutter and debris. There are no clear walkways. ADU/Caregiver Room The caregiver room is currently being rented to a tenant not associated to the facility. Applicant expressed intent to relocate the tenant prior to accepting residents, with the date of move out unknown at this time. Liability Insurance: Facility does not currently have liability insurance. Component III: Component III was waived because Applicant is operating other licensed facilities and has fulfilled this requirement. CONTINUE TO LIC809-C .... The following items require correction: Clear passageways in the garage and yard. Store water hoses on respective racks. Install grab bars in all bathrooms Ensure that the home/resident’s bedroom spaces and garage are de-cluttered and ready for use Regulate water temperatures in all bathrooms to measure between 105 and 120 degrees Fahrenheit. Adequately stock non-perishable food and emergency water supplies Remove hospital bed and rails and replace with bed approved for residents use Deep clean inside and outside of physical plant to ensure facility is sanitary and in good repair Ensure ADU is occupied by facility staff only and person(s) are associated with facility Ensure all emergency supplies which include but are not limited to such as large & small flashlight, propane/gas lanterns with back up propane, small portable stove, whistle/bell, charger, and cooler are obtained per the Emergency Disaster Plan (LIC610E) Amend the LIC610E reflecting the type of residents served (non-ambulatory, bedridden) Missing postings- Ombudsman poster, food menu, visitor hours and policy, and admission agreement. Submit proof of liability insurance policy Based on today’s observation, the facility is not ready for licensure. A subsequent visit will be conducted to review the corrections on October 23, 2025 and Applicant will contact the department if an extension is needed. An exit interview was conducted with Applicant Moe Jerrar, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Oct 9, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITL Capacity: 06 Census : 0 Method: Telephone call with CAB COMP II Participants: ABDALLA, SUHA; DEGMETICH, JOSHUA (analyst) Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee'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, Aug 27, 2025