336426201-5-13-2021-18-AS-NBRN-C3CTPS-20210525145443

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426201
Report Date: 05/13/2021
Date Signed: 05/13/2021 01:41:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/15/2020 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200915103110

FACILITY NAME:	GRANDVIEW MANOR		FACILITY NUMBER:	336426201
ADMINISTRATOR:	JASON NAZARENO		FACILITY TYPE:	740
ADDRESS:	4411 CHICAGO AVENUE		TELEPHONE:	(951) 781-8400
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92507
CAPACITY:	82	CENSUS: 68	DATE:	05/13/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator Jason Nazareno		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident is unkempt
Resident elopes from the facility

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 5/13/21 Licensing Program Analyst (LPA) Shaunte Henry conducted a tele-inspection due to COVID-19 in order to deliver the findings for the above allegations. LPA Henry provided the findings to Administrator Jason Nazareno.

The investigation consisted on interviews and document review. Interviews revealed Resident 1 (R1) maintains a clean and groomed appearance. Interviews revealed that the facility staff will accompany R1 on walks. Interviews revealed that R1 has never eloped from the facility. The LPA was unable to corroborate the the allegations the resident is unkempt and elopes from the facility, therefore both allegations are unsubstantiated. 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report was provided to Jason Nazareno.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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