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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881456
Report Date: 09/11/2023
Date Signed: 09/11/2023 10:05:45 AM


Document Has Been Signed on 09/11/2023 10:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:GRANDVIEW MANORFACILITY NUMBER:
331881456
ADMINISTRATOR:SHALABI, JAMALFACILITY TYPE:
740
ADDRESS:4411 CHICAGO AVETELEPHONE:
(337) 244-2252
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:82CENSUS: 73DATE:
09/11/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Jamal Shalabi -Licensee TIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Sara Martinez conducted an announced pre-licensing inspection to the facility to complete the pre-licensing inspection. LPA arrived at the facility and was granted entry and met with Licensee Jamal Shalabi. Licensee Shalabi accompanied LPA on a tour of the inside and outside of the facility.

The pre-licensing inspection is a CHOW (Change of Ownership) and the facility has a current census of 73 residents. The facility has 41 bedrooms, 42 bathrooms, a common area, a kitchen and dining room, a laundry room, three (3) storage rooms and a courtyard. The facility does not have any bodies of water, firearms, or ammunition on the property. Per the approved fire clearance, the licensee is approved for seventy-six (76) nonambulatory residents and six (6) bedridden residents.

All bedrooms are furnished with beds, night stands, dressers and have adequate lighting for residents use. Each resident's bedroom has a bathroom attached. The facility has an adequate supply of linens, towels, and a sufficient amount of hygiene products for residents when needed located in the storage rooms. The water temperature was tested and measured 105.1 F. The smoke alarms, carbon monoxide alarm, and sprinkler system were tested and are in operating order. LPA observed fire extinguishers located throughout the facility. The kitchen was observed to have dishes, silverware and pots and pans and the knives were kept locked in the kitchen area. The facility received food deliveries twice a week. LPA observed locked medication cabinets and locked medication refrigerator located in the dining room area. The chemicals are stored in a locked laundry room.

The courtyard was observed to be fully fenced, clear from any hazards or obstructions, and has shade and seating area for the residents.

LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA have determined that the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete, and this facility has no deficiencies. The facility has satisfied all requirements in accordance with Title 22, California Code of Regulations.



An exit interview was conducted and a copy of this report was reviewed with and provided to Licensee Jamal Shalabi.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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