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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605235
Report Date: 03/19/2025
Date Signed: 03/19/2025 01:46:51 PM

Document Has Been Signed on 03/19/2025 01:46 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:
03/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Belinda Rene HicksTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 03/19/2025, Licensing Program Analyst (LPA) Lorena Casillas arrived at facility and met with facility staff. The Administrator, Belinda Rene Hicks was contacted and met with LPA shortly after for an annual required inspection. Entrance interview conducted.

A tour of the physical plant was conducted with the staff at 10:20 am. The facility has five (5) bedrooms and two (2) bathrooms. Three (3) rooms are used for clients, one (1) room is used for storage and one (1) room is a staff bedroom. Facility is fire cleared for two (2) ambulatory clients and two (2) non ambulatory for a total of four (4) clients. The following was observed:

Infection Control: LPA reviewed Infection control plan that was approved on 07/12/2022 to make sure that facility is following said plan.

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 72 degrees F. LPA observed fire extinguisher to be full and last purchased on 04/24/2024. At 10:40 am, staff tested the carbon monoxide and interconnected smoke detectors, all were functioning properly.

Kitchen: LPA toured the kitchen at 10:50 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.

Continued on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GRANGE GUEST HOME, INC.
FACILITY NUMBER: 197605235
VISIT DATE: 03/19/2025
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Client Bedrooms: LPA toured the client rooms and observed rooms to have appropriate bedding, a chair, a nightstand and sufficient lighting for each client. One (1) client bedroom does not have a bed, only a mattress per client request. Client refuses to have bed frame in the room and voluntarily removed bed themselves. LPA was able to observe that bed frame and mattresses are kept in the storage bedroom in case client decides to put bed back in the room.

Bathrooms: At 11:00 am LPA observed all bathrooms to have appropriate grab bars and wash your hand signs. Hot water was measured within regulation at 105.5 degrees F.

Laundry service: The laundry room remains locked at all times and was observed to be neat and clean. Detergents and chemicals were observed to be in a locked cabinet within the laundry room.

Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with an umbrella for shade. 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.

Client/Staff Interviews: All clients were out in the community at day program and doctors’ appointments. No clients were interviewed. Two (2) out of two (2) staff present were interviewed.

Client/Staff Files: LPA conducted a file review of staff and client records to ensure forms and training are up to date and compliance with licensing forms.

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

Administrative: LIC500, Bond, Administrator Certificate and client roster collected. Annual fees are current.
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: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
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