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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605235
Report Date: 04/21/2023
Date Signed: 04/21/2023 12:30:11 PM

Document Has Been Signed on 04/21/2023 12:30 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:GRANGE GUEST HOME, INC.FACILITY NUMBER:
197605235
ADMINISTRATOR:JOEL FLETCHERFACILITY TYPE:
735
ADDRESS:43518 GRANGE STREETTELEPHONE:
(661) 948-9258
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
04/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Margarita Goroza, CaregiverTIME COMPLETED:
12:45 PM
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On 4/18/23, Licensing Program Analyst (LPA) Shira Stamps arrived at 10:00 am and met with facility staff. The Administrator was contacted and met with LPA at 10:15 am for an annual required inspection.
Entrance interview conducted.

LPA and the Administrator conducted a tour of the facility at 10:30 am. The following was observed:
LPA observed the license posted and the Complaint Poster.

Common Areas: LPA toured all common areas of the facility. LPA observed common areas to be clean and furniture to be in good repair. The facility maintains a comfortable temperature in both buildings at 72 degrees F. LPA observed fire extinguisher to be full and serviced. At 11:20am, the Administrator tested the carbon monoxide and smoke detectors.

Resident rooms: LPA toured the client rooms and bathrooms. LPA observed rooms to have appropriate bedding sheets, pillowcase, mattress pad, and blankets) which are in good condition. There is at least one chair, nightstand and sufficient lighting for each client.

Bathrooms: At 10:33 am LPA observed all bathrooms to have appropriate grab bars and wash your hand signs. Clients have sufficient amounts of supplies for personal hygiene which is provided by the Licensee. Hot water was measured with in regulation of 105 degrees F and 120 degree F.

Laundry service: There is enough linen available to change weekly or more if need. The Laundry room remains locked at all times and was observed to be neat and clean.

CONTINUED...
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GRANGE GUEST HOME, INC.
FACILITY NUMBER: 197605235
VISIT DATE: 04/21/2023
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Laundry service: There is enough linen available to change weekly or more if need. The Laundry room remains locked at all times and was observed to be neat and clean.

Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. The umbrella is stored in the garage due to windy weather. LPA observed no bodies of water on the premises.

Food Inspection: LPA conducted a food inspection tour at 10:30 am. LPA observed there to be sufficient stock of two- perishable and seven-day non-perishables foods. The menu was posted for review. Snacks and beverages are available for clients in the facility when they want. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. LPA observed an extra refrigerator and deep freezer located in the garage for overflow of foods. LPA observed the knives and chemicals locked under the sink and observed the medication cabinet locked and inaccessible to clients in care.

Personnel Records: LPA reviewed five (5) staff records. Staff are fingerprint cleared. LPA observed the Administrator certificate to be valid. All five (5) staff have current first aid and cpr.

LPA was having computer issues and was unable to continue the inspection. On 4/21/23, LPA returned to continue the annual inspection and deliver the report.

Deficiencies were issued per CA code of Regulations Title 22 or Health and Safety Code. See 809D's included with this report. Appeal rights issued.

The Administrator designated staff member to sign report, since Administrator had to leave during inspection.

Exit interview conducted. Copy of report delivered to Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
LIC809 (FAS) - (06/04)
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