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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881456
Report Date: 05/29/2026
Date Signed: 05/29/2026 12:57:47 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
11/15/2024 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20241115151741
FACILITY NAME:GRANDVIEW MANORFACILITY NUMBER:
331881456
ADMINISTRATOR:SHALABI, JAMALFACILITY TYPE:
740
ADDRESS:4411 CHICAGO AVETELEPHONE:
(909) 781-8400
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:82CENSUS: 82DATE:
05/29/2026
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:SHAMABI JAMALTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Staff did not ensure that resident received proper nourishment.
Staff did not ensure resident was hydrated.
Staff did not ensure resident was provided a healthful environment.
INVESTIGATION FINDINGS:
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On May 29, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced follow-up complaint visit. The LPA met with the Administrator (A1), Shalabi Jamal, and explained the purpose of the visit.

The investigation included collecting records and touring the facility. On May 20, 2026, the Department obtained various documents, including the Personnel Report LIC 500 (dated 02/26/26) and the Client Roster (dated 03/29/26). The Department reviewed and collected documents for resident #1 (R1), including the Admission Agreement, the physician's Report, the Medical Assessment, the unusual incident report dated 11/15/24, the death report dated 01/11/25, and the facility menu dated 05/01/2026. The Department interviewed the Administrator (A1) and four staff members (S1- S4). The department interviewed eight Residents (R2-R9). The department is unable to interview the resident R1 because R1 passed away on January 11, 2025.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
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 5
Control Number 18-AS-20241115151741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: GRANDVIEW MANOR
FACILITY NUMBER: 331881456
VISIT DATE: 05/29/2026
NARRATIVE
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Allegation #1: Staff did not ensure that residents received proper nourishment.

The complaint alleged that a resident was not alert, oriented, and was severely malnourished and looked to have not been provided with food and water. On May 20, 2026, the department conducted an interview with the Administrator (A1), who denied the allegation regarding inadequate nourishment. A1 stated that the residents (R1) receive three meals a day, with snacks between meals, and that R1 does not require assistance to eat and does not refuse meals.

On the same day, the department interviewed four staff members (S1-S4), all of whom denied the allegations and affirmed that the facility provides three meals a day and snacks. S1 and S2 indicated that if a doctor orders a special diet for a resident, the kitchen ensures that the meals are prepared with the necessary ingredients. They also mentioned that the facility maintains a four-week rotating menu, allowing residents to know in advance what will be served each week and providing a variety of dishes.

Additionally, the department interviewed eight residents (R2-R9), who reported being adequately nourished. Some stated that they find the food acceptable and that the facility's menus are satisfactory. A few residents mentioned that if they do not like the food provided, they can purchase their own meals.

Report Continued on LIC9099C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20241115151741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: GRANDVIEW MANOR
FACILITY NUMBER: 331881456
VISIT DATE: 05/29/2026
NARRATIVE
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Unfortunately, the department was unable to interview R1, because R1 passed away on January 11, 2025, at Riverside Community Hospital. A review of the records including R1's physician report dated September 26, 2023, and 2024 indicated that R1 was not on any special diet. The department also reviewed the facility's weekly menu, which demonstrated that a variety of meals are regularly offered to the residents. On May 20, 2026, the department observed the facility serving lunch; the meals included a variety of dishes, along with juice and water.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur, therefore, the allegation is Unsubstantiated.

Allegation #2: Staff did not ensure that the residents were hydrated.

The complaint alleged that the staff did not provide water for the residents. On May 20, 2026, the department interviewed the Administrator (A1), who denied the allegation. A1 stated that the facility has water dispensers located throughout the building, including in the dining room, living room, activities room, and hallway, allowing residents to drink as much water as they need. During lunch and dinner, both juice and water are offered.

On the same day, the department interviewed four staff members (S1-S4), all of whom also denied the allegation. They confirmed that the facility has dispensable water that is constantly refilled and that meals are served with both juice and water.

Report continued on LIC9099C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20241115151741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: GRANDVIEW MANOR
FACILITY NUMBER: 331881456
VISIT DATE: 05/29/2026
NARRATIVE
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On May 20, 2026, the department reviewed an unusual incident report dated November 15, 2024, that the facility submitted to the Community Care Licensing Department about R1's hospitalization, as well as R1's death report dated January 11, 2025. The department also observed several water dispensers with disposable cups at the facility; all filled with plenty of water.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur, therefore, the allegation is Unsubstantiated.

Allegation #3: The staff did not ensure resident was provided a healthy environment.

The complaint alleged that the facility had neglected the resident for some time, given the resident's condition. On May 20, 2026, the department interviewed the Administrator (A1), who denied the allegation and stated that the facility supports residents' physical, social, and mental well-being by providing access to clean drinking water and activities, and by ensuring the absence of toxic chemicals, excessive noise, and dangerous living conditions. We also offer a healthy menu featuring fruits, vegetables, green salads, desserts, and various meats. On the same day, the department interviewed four staff members (S1-S4), all of whom denied the allegation and stated that the facility provides a healthy place for residents. We schedule activities twice a week and ensure residents' rooms are kept clean. Meals are served with juice and water.

Report continued on LIC9099C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20241115151741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: GRANDVIEW MANOR
FACILITY NUMBER: 331881456
VISIT DATE: 05/29/2026
NARRATIVE
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At the same time, the department interviewed eight residents (R2-R9), who denied the allegation and stated that they do whatever they want—most of them like sitting outside or in the activity room watching TV.

However, the department was unable to interview R1 because R1 passed away on January 11, 2025, at Riverside Community Hospital. The department also observed that the facility was not in disrepair and was clean. Some residents were sitting in the living room watching TV, some in the activity room, and some were sitting outside.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur, therefore, the allegation is Unsubstantiated.

No deficiencies were cited.

An exit interview was conducted. A copy of this report was provided to the Administrator. Shalabi Jamal.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5