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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200359
Report Date: 08/14/2024
Date Signed: 08/14/2024 12:53:32 PM

Document Has Been Signed on 08/14/2024 12:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:GRANGER CARE HOMEFACILITY NUMBER:
019200359
ADMINISTRATOR/
DIRECTOR:		PERLA V. GARCIAFACILITY TYPE:
735
ADDRESS:30751 GRANGER AVENUETELEPHONE:
(510) 972-0954
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 6CENSUS: 6DATE:
08/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Teresita CruzTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On this day at around 10:10 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct an annual required inspection and met with staff Teresita Cruz. LPA explained to Cruz the purpose of the visit.

During the visit, LPA inspected the facility inside and out including but not limited to client bedrooms, bathroom, dining area, kitchen, garage and backyard. There were no bodies of water observed. Passageways and hallways were free of obstruction. Hot water in the kitchen measured at 113.5 Fahrenheit.
There was sufficient supply of perishable and non perishable foods. Smoke detectors and carbon monoxide were tested and observed functional. Fire extinguisher that appeared full and was last serviced on 9/12/2023 was observed.

At 10:38 am, LPA and staff reviewed P&I money and log. There was sufficient amount of surety bond to cover cash being handled at one time. First aid kit was observed complete.

At 10:51am, LPA reviewed 6 client files and 4 staff files. All staff are fingerprint cleared and associated to the facility. They have current First aid and CPR training.

At 12:15 pm, LPA reviewed medications and Medications Administration Record (MAR).

There are no deficiencies noted during this visit.

Exit interview was conducted with Cruz and a copy of this report was provided.


SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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