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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880833
Report Date: 09/23/2025
Date Signed: 09/23/2025 01:46:42 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
09/15/2025 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20250915090751
FACILITY NAME:NICK'S MAPLE HOME IIFACILITY NUMBER:
361880833
ADMINISTRATOR:HAMED, NAJEHFACILITY TYPE:
740
ADDRESS:1065 W HUFF STREETTELEPHONE:
(909) 440-5252
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:8CENSUS: 6DATE:
09/23/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Yusef Nofal, Licensee TIME COMPLETED:
01:52 PM
ALLEGATION(S):
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Staff speak inappropriately to residents.
Staff preparing meals resident unable to consume.
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Lavette Farlow, conducted an unannounced visit to the facility to commence a complaint investigation. LPA was greeted and granted entrance by Caregiver Malik Salem. LPA identified self and discussed the purpose of the visit. LPA also presented self to Licensee, Yusef Nofal and discussed the purpose of the visit. LPA conducted interviews with staff and residents, reviewed documents and did a walk-through of the facility.

It is alleged that staff speak inappropriately to residents. LPA interviewed (3) three staff members and four (4) residents. LPA interview with staff revealed that three (3) out of three (3) staff stated they have not spoken to residents in care inappropriately. 3 out of staff stated they have not used profanity with resident in care and staff assist residents as needed with daily ADL's. LPA interviewed four residents in care and it was revealed that four out of four resident stated staff have not spoken inappropriately to residents in care, and five (5) out of (6) residents are able to complete daily ADL's without assistance. It was reveal that a long time ago staff spoken inappropriately to residents in care. Based on interviews, with residents and staff the allegation is UNSUBSTANTIATED.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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 2
Control Number 56-AS-20250915090751
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: NICK'S MAPLE HOME II
FACILITY NUMBER: 361880833
VISIT DATE: 09/23/2025
NARRATIVE
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It is alleged that staff prepare meals resident are unable to consume. LPA interviewed (3) three staff members and four (4) residents. LPA interview with staff revealed that three (3) out of three (3) staff stated that the residents enjoy the meals and they have not heard any complaints. 3 out of 3 staff stated they ask resident what they would like to eat and encourage residents input on the menu. LPA interviewed four residents in care and it was revealed that four out of four resident were satisfied with the food options and staff provide different meal options. Based on interviews with residents and staff the allegation is UNSUBSTANTIATED.

Based on the information above, the allegations are unsubstantiated. A finding of UNSUBSTANTIATED means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report LIC9099 and LIC9099C was discussed, and a copy was provided to Caregiver Malik Salem.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2