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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881456
Report Date: 05/21/2026
Date Signed: 05/21/2026 11:27:35 AM

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
04/26/2024 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20240426101158
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:
05/21/2026
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Shalabi JamalTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff member physically assaulted resident.
Staff member yelled at resident.
INVESTIGATION FINDINGS:
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On May 21, 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 one resident #1 (R1), including the Admission Agreement, the physician's Report, the Medical Assessment, the unusual incident report dated 12/16/25, and the death report dated 12/17/25. The Department interviewed the Administrator (A1) and four staff members (S1- S4). The department interviewed eight Residents (R2-R9) but was unable to interview Resident (R1) because R1 had passed away on December 16, 2025.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
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 3
Control Number 18-AS-20240426101158
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: 05/21/2026
NARRATIVE
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Allegation #1: Staff member physically assaulted resident.

The complaint alleged that a staff member working on utilities hit the resident while entering the resident's (R1) room. On May 20, 2026, the department interviewed the Administrator (A1), who denied the allegation and stated that construction workers were working on the utility outside in the hallway. Then, resident R1 accused them of hitting R1, which had never happened. On the same day, the department interviewed four staff members (S1-S4), all of whom denied the allegation and stated that they would never physically hit a resident. S2 and S4 stated that residents physically push staff when they are mad. At the same time, the department interviewed eight residents (R2-R9), who denied that staff ever hit them. Some stated they noticed residents being physically aggressive toward staff members. The department was unable to interview R1 because R1 passed away on December 16, 25, at Riverside Community Hospital. The department records reviewed of the facility rosters and the Licensing Information System (LIS) showed no staff member by the name of the suspected abuser that was provided.

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.

The Report Continued on LIC9099C

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

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240426101158
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: 05/21/2026
NARRATIVE
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Allegation #2: Staff member yelled at resident.

The complaint alleged that while staff entered R1’s room with a broom, they began yelling at R1. On May 20, 2026, the department interviewed the Administrator (A1), who denied the allegation and stated that construction workers were fixing the utilities outside R1’s room. R1 accused them of yelling because R1 didn’t like the worker working outside R1's room. They never touched or yelled at R1. On the same day, the department interviewed four staff members (S1-S4), all of whom denied the allegation and stated that they would never yell at a resident. S4 stated that some residents are stubborn and refuse to follow orders, so they had to repeat instructions more than once, but never in a yelling manner. At the same time, the department interviewed eight residents (R2-R9), who denied that staff ever yelled at them. Some stated they noticed residents being aggressive and cursing staff members. The department was unable to interview R1 because R1 passed away at Riverside Community Hospital on December 16, 2025. On May 20, 2026, the department’s review of the facility rosters, and the Licensing Information System (LIS) showed no staff member by the name of the suspected abuser that was provided.

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: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3