197610291-9-30-2022-31-AS-SSTS-CJRPT7-20220930113529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610291
Report Date: 09/30/2022
Date Signed: 09/30/2022 11:36:13 AM

Document Has Been Signed on 09/30/2022 11:36 AM - 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:	GRANVILLE RESIDENTIAL CARE		FACILITY NUMBER:	197610291
ADMINISTRATOR:	SCOTT, SONYA		FACILITY TYPE:	735
ADDRESS:	1656 GRANVILLE WAY		TELEPHONE:	(562) 316-7038
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 6		CENSUS: 0	DATE:	09/30/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Sonya Scott, Licensee		TIME COMPLETED:	11:45 PM

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Licensing Program Analyst (LPA) Shira Stamps met with Sonya Scott (Licensee/Applicant) and (Administrator) for a Pre-licensing inspection at 10:05am.

Entrance interview conducted.

The home will be vendored by North Los Angeles Regional Center. The home will serve six (6) level 4 intellectually disabled adults. The facility has four (4) bedrooms and four (4) bathrooms designated for a capacity of six (6) clients. Staff will be awake at night.

The physical plant was toured inside and out at 10:15 am.

Common Area: LPA observed the living room and furniture to be clean and in good repair. LPA observed the dining area to be clean and in good repair. The facility maintains a comfortable temperature at 72 degrees F, which meet regulations. The air conditioner is operational. No firearms observed or will be maintained on the premises.

The smoke alarm and carbon monoxide detector were operational and tested at 10:34 am. The fire extinguisher appears to be full, and last serviced on 5/13/22.

Resident rooms: Rooms available are all shared. LPA observed rooms to have bedding sheets, pillowcase, blankets, mattress pads, which are in good condition. There is at least one chair, a nightstand, and sufficient lighting for each client.

Window covering and window screens are in good repair for each room.

Consumers will have sufficient amounts of supplies for personal hygiene products, which is provided by the Licensee. Continued...

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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: GRANVILLE RESIDENTIAL CARE	FACILITY NUMBER: 197610291
	VISIT DATE: 09/30/2022

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Bathrooms: LPA toured the bathrooms and checked to make sure bathrooms were clean and in good repair. The hot water temperature measured within regulations at 112 degrees F. Each shower contained non-skid mats. Trash cans with lids were in the restroom to protect consumers from cross contamination. Towels and washcloths will not be shared.

Kitchen Area: LPA inspected kitchen equipment. The refrigerator was clean and in good operation. Dishes in good repair. Knives and cleaning supplies will be kept locked inaccessible in the kitchen and the laundry room.

Medications will be kept centrally stored and locked in the hallway closet. Stove and refrigerator are clean and in good operation. LPA observed sufficient supply of 7-day non-perishable foods.

Outside: LPA toured the outside area. LPA observed a covered shaded area for clients. There are no bodies of water on the premises. The locked shed will hold tools and paint.

Garage: The garage is attached to the facility, and entry is attached to the locked laundry room. Extra supplies will be kept in the garage.

Files will be kept confidentially stored in the locked hallway and supplied to licensing staff upon request.

LPA discussed preplacement, staffing, training, customer service, inspection authority, reporting requirements (mandated reporter), records, citations, criminal record clearance, civil penalties, labor law, activities, expectation is to follow all rules and regulations.

Applicant/ Administrator has completed component III.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC809 (FAS) - (06/04)

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