<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605235
Report Date: 05/01/2024
Date Signed: 05/01/2024 03:52:59 PM

Document Has Been Signed on 05/01/2024 03:52 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:GRANGE GUEST HOME, INC.FACILITY NUMBER:
197605235
ADMINISTRATOR/
DIRECTOR:		JOEL FLETCHERFACILITY TYPE:
735
ADDRESS:43518 GRANGE STREETTELEPHONE:
(661) 948-9258
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
05/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Belinda HicksTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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
On 05/01/2024, Licensing Program Analyst (LPA) Lorena Casillas arrived at 10:00 am and met with facility staff. The Administrator, Belinda Hicks was contacted and met with LPA at 10:10 am for an annual required inspection. Entrance interview conducted.

Administrative: LIC500, Bond and client roster collected. Annual fees are current.

Infection control plan approved on 07/12/2022.

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

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 at 71 degrees F. LPA observed fire extinguisher to be full and purchased on 04/24/2024. At 11:15 am, the Administrator tested the carbon monoxide and smoke detectors.

Kitchen: LPA toured the kitchen at 10:30 am. LPA observed there to be sufficient stock of two-day perishable and seven-day non-perishables foods. The menu was posted for review. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed the knives and chemicals locked under the sink and observed the medication cabinet locked and inaccessible to clients in care.

Resident rooms: LPA toured the client rooms and bathrooms. LPA observed rooms to have appropriate bedding, a chair, a nightstand and sufficient lighting for each client.

Continued on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GRANGE GUEST HOME, INC.
FACILITY NUMBER: 197605235
VISIT DATE: 05/01/2024
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
Bathrooms: At 10:35 am LPA observed all bathrooms to have appropriate wash your hand signs. Hot water was measured within regulation at 107.6 degrees F.

Laundry service: 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.



Garage: LPA observed an attached garage that is locked and inaccessible to clients. The garage is used for extra storage. LPA observed an extra refrigerator and deep freezer located in the garage for overflow of foods.

Staff Interviews: At 11:30 am LPA interviewed staff.

Client Interviews: Two (2) clients present and two (2) clients at day program. One (1) out of two (2) clients were able to be interviewed.

Staff files: LPA conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms at 12:00 pm.

Resident files: LPA conducted a file review of resident records to ensure compliance of licensing forms at 12:30 pm.

Medications: At 1:05 pm LPA and Administrator reviewed medication and medication records for proper documentation.

No citations issued. Exit interview conducted. Copy of report provided to Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2