336426201-8-25-2021-18-AS-JESL-C7C226-20210929170014

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426201
Report Date: 08/25/2021
Date Signed: 08/25/2021 05:52:27 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
08/16/2021 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210816102840

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: 67	DATE:	08/25/2021
		UNANNOUNCED	TIME BEGAN:	01:38 PM
MET WITH:	Administrator Jason Nazareno		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Illegal eviction.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Javina George arrived unannounced at the facility to investigate and deliver findings for the allegation listed above. LPA met with Administrator Jason Nazareno and explained the purpose of the visit as well as the elements of the allegation. The allegation was investigated by the department. The investigation consisted of observation interviews and record review.

Allegation: Illegal eviction
LPA interviewed Administrator and staff whom stated that the facility had issued thirty eviction notices for a total of two residents. Resident #1 (R1) eviction was issued on 5/25/21, for multiple reasons. Refusing to see the Doctor, refusing to see the psychiatrist, being verbally aggressive towards staff and residents and physically threatening staff and other residents. R1 has a bloody growth on their nose, that they cover with tissue. R1s psych medication had to be stopped due to the Psychiatrist not being able to see R1, and refused to have their labs completed. Per Administrator he believes that R1 understood what the notice meant, however R1 refused to sign it.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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 2

Control Number 18-AS-20210816102840

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GRANDVIEW MANOR	FACILITY NUMBER: 336426201
	VISIT DATE: 08/25/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Administrator followed up with R1 on 5/31/21, in regards to the notice and R1 became aggressive warranting law enforcement to be contacted. Per Administrator the responding Officer stated that it is good the notice has been issued, and made note of what they observed, however R1 refused to take the eviction and ran away.

LPA reviewed R1s file and the supervisory notes dated back to 1/15/20 revealed where R1 had refused to be sent to the hospital to have their nose checked. 1/27/20 another attempt was made to get R1s nose checked. 1/28/20 an Adult Protective Services (APS) report was filed by the facility for the refusal of medical treatment. APS responded to the facility and R1 refused to meet with APS worker. There are multiple entries noting similar incidences as mentioned above.

R1 has lived at the facility since January 1, 2015, and does not have a responsible party. Per administrator R1 was sent out on a 51/50 on 8/14/21. However R1 was medically cleared to return to the facility on 8/16/21 and the facility refused to accept R1 back. R1 had been left at the hospital with nowhere to go. It was explained to Administrator that the facility is responsible for R1 as they took R1 into their care in January 2015. Therefore, the facility would need to accept R1 back and assist with what is recommended by the Doctor. Based on observation, interview and record review the allegation of illegal eviction is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

R1 returned back to the facility on 08/25/21 at 5:45pm.

An exit interview conducted and a copy of this report, 9099c and appeal rights were provided to Administrator Jason Nazareno.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2