361880833-12-1-2025-56-AS-NBRN-DNYR7Q-20251202114639

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880833
Report Date: 11/25/2025
Date Signed: 12/01/2025 06:32:04 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
11/08/2023 and conducted by Evaluator Lavette Farlow

COMPLAINT CONTROL NUMBER: 56-AS-20231108143629

FACILITY NAME:	NICK'S MAPLE HOME II		FACILITY NUMBER:	361880833
ADMINISTRATOR:	HAMED, NAJEH		FACILITY TYPE:	740
ADDRESS:	1065 W HUFF STREET		TELEPHONE:	(909) 440-5252
CITY:	RIALTO	STATE: CA	ZIP CODE:	92376
CAPACITY:	8	CENSUS: 6	DATE:	11/25/2025
		UNANNOUNCED	TIME BEGAN:	01:04 PM
MET WITH:	Ahmad Abdallatef, Administator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not seek medical attention for resident in care in a timely manner.
Staff did not prevent resident from wandering from the facility while in care.
Staff do not ensure that resident is provided a sufficient amount of food while in care.
Staff do not ensure that resident is administered their medication(s) as prescribed.
Licensee is financially abusing resident in care.
Facility has a pest infestation.
Staff do not allow resident(s) to make and receive telephone calls while in care.
Staff do not allow resident to have access to their personal possessions while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) LaVette Farlow conducted an unannounced visit to the facility to conclude the investigation and deliver findings to the above mentioned complaint. LPA met with Administrator, Ahmad Abdallatef who was informed of the reason for today's visit. The investigation consisted of interviews with residents and staff, reviewed and collected documents.

Allegation 1: It is alleged that staff did not seek medical attention for resident in care in a timely manner. Interview with residents R3, R4, and R8 stated that staff are providing medical attention in a timely manner. LPA interview with S1, S2, S3, and S4 revealed that the facility provides medical attention in a timely manner.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025

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-20231108143629

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: 11/25/2025

NARRATIVE

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Allegation 2: It is alleged that staff did not prevent resident from wandering from the facility while in care. LPA interviews with staff and residents revealed that staff is providing proper supervision for residents in care. S4 stated he does not recall a situation where any residents or R1 has wandered off and the police were called.

Allegation 4: It is alleged that staff do not ensure that residents are provided a sufficient amount of food while in care. Interviews with R3, R4, R5, and R8 revealed that staff do provide a sufficient amount of food for residents in care. LPA interviewed staff. Interview with, S1, S2, S3 and S4 revealed that staff are providing sufficient amount of food for residents in care. LPA Coleman previous report revealed that LPA observed the facility with sufficient amount of food and the residents had access to food in the facility. During LPA visit today LPA observed the facility has sufficient amount of food for residents in care and the residents had access to food. LPA observed the cabinet, and refrigerator was accessible to residents in care and not locked.

Allegation 5: It is alleged that staff do not ensure that residents are administered their medication(s) as prescribed. Interview with residents R3, R4, R5, and R8, revealed that staff are providing medication as prescribed by their doctors. LPA interviewed staff. Interviews with S1, S2, S3 and S4 revealed that staff are dispensing medication according to doctors’ orders. During todays visit LPA audited the residents MARS and there were no discrepancies and medication appears to be dispensed as prescribed.

Allegation 6: It is alleged that Licensee is financially abusing resident in care. LPA interviewed residents R3, R4, R5, and R8, and residents stated that they handle their own finances. LPA Coleman reviewed residents files in 2023 and it was revealed that residents are handling their own finances. LPA Farlow interviewed and reviewed residents files and it was revealed that the facility does not manage residents finances.

Allegation 7: It is alleged that Facility has a pest infestation. In 2023 LPA Coleman investigation revealed that the Licensee has a monthly Pest Control Service contract with Freedom Pest Extermination Inc. During today’s visit LPA observed the facility still maintains a monthly contract with Freedom Pest Extermination, and LPA Farlow did not observe any signs of an infestation. LPA Coleman interviews with R3, R4, R5, and R8 revealed that the residents were not aware of any problems with pest. LPA Farlow interview with staff revealed that there is not a problem with pest control.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20231108143629

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: 11/25/2025

NARRATIVE

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Allegation 8: It is alleged that staff do not allow resident(s) to make and receive telephone calls while in care. In 2023 LPA Coleman reviewed documents that revealed the facility maintain a monthly bundle service for cable, internet, and phone service. Also, during the visit in 2023 the Administrator called the facility phone, and LPA Coleman observed the facility maintain an active service. Interview with residents R3, R4, R5, and R8, stated that the residents are allowed access to the facility phone to receive and make calls. Interviews with S1 S2, S3, and S4 revealed that residents are allowed to make and receive phone calls.

It is alleged that staff do not allow residents to have access to their personal possessions while in care. LPA Farlow conducted interviews with staff and residents. Interviews with staff S3, S4, and S5 revealed that residents maintain their own personal belongings. Interview with residents R3, R4, and R10 stated that they maintain their own personal belongings. Residents stated they have not been denied access to their personal belongings. LPA Farlow conducted a tour of the facility and observed residents with their personal belongings in their rooms. LPA observed clothing, hygiene items, pictures, books, and varies gadgets.

Based on the information above, the allegations are unsubstantiated. A finding of UNSUBSTANTIATED means although the allegation 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 LIC 9099 and LIC9099C was discussed, and a copy was provided to Administrator, Ahmad Abdallatef.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025

LIC9099 (FAS) - (06/04)

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