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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610291
Report Date: 11/03/2025
Date Signed: 11/03/2025 11:13:38 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/03/2025 11:13 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:GRANVILLE RESIDENTIAL CAREFACILITY NUMBER:
197610291
ADMINISTRATOR/
DIRECTOR:		SCOTT, SONYAFACILITY TYPE:
735
ADDRESS:1656 GRANVILLE WAYTELEPHONE:
(562) 316-7038
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 0DATE:
11/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Kaiya ThompsonTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On 11/03/2025 Licensing Program Analyst (LPA) Lorena Casillas arrived at facility for an unannounced one (1) year Required visit.

LPA Casillas arrived at 09:30 am, LPA was able to speak to Administrator and was told they would be designating staff member Kaiya Thompson to sign the report as they would not be able to meet with LPA today. LPA explained the reason for the visit and entrance interview was conducted.

A tour of the physical plant was conducted with designee at 09:35 am. The facility has four (4) bedrooms and four (4) bathrooms currently occupying no clients. The tool kit was not used on this visit as there are no clients.

Infection Control: LPA Casillas reviewed the facility Infection Control Plan submitted on 12/08/2022 to make sure protocols are being followed. LPA’s temperature was taken at the door by staff and questionnaire filled out before entry was allowed.

Living and Dining: At 09:35 am, LPA observed the living room and family room area to be neat and clean along with the dining room. LPA observed the locked medication cabinet for client medications. The facility maintains a comfortable temperature at 70°F. There is one (1) fire extinguisher located in the kitchen and one (1) fire extinguisher in the hallway, last purchased on 04/01/2025. The carbon monoxide detector and smoke detector were tested and observed to be operational at 09:40 am.

Continued on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Lorena Casillas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: GRANVILLE RESIDENTIAL CARE
FACILITY NUMBER: 197610291
VISIT DATE: 11/03/2025
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Kitchen: LPA conducted a tour of the kitchen around 9:50 am and observed a supply of seven-day non-perishable and frozen foods. There is some perishable foods, however two day perishable foods will be purchased when there are clients present. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. Knives are stored in the cabinet above the kitchen stove and are double locked and inaccessible to clients.

Bathrooms: At 10:00 am LPA observed all bathrooms to have non-skid matts and the appropriated wash your hands signs posted in the bathroom. Hot water was tested and measured within regulation at 119.7˚ F.

Resident Rooms: At 10:15 am, LPA observed rooms to have the appropriate bedding. There is a nightstand, a chair and sufficient lighting for each resident. Two (2) rooms are designated for clients and will be shared, two (2) rooms are designated as staff rooms.

Laundry: At 10:25 am, LPA observed a locked laundry room with locked cabinets for chemicals/toxins. LPA observed detergents and cleaning supplies in the locked cabinet.

Hallway Closet: LPA observed a locked closet in the hallway. Emergency backpacks, emergency food and client/staff files are located in the closet.

Garage At 10:35 am LPA observed the attached garage used for extra storage. LPA observed additional emergency food, emergency water and an emergency generator located in the garage.

Physical Environment: LPA toured the outside area of the facility at 10:45 am. LPA observed appropriate outdoor furniture. LPA observed umbrellas, patio tables and chairs for clients to use. There are no bodies of water on the premises.

Administrative: Annual fee is current.

Resident Files: There are currently no clients. Staff Files: At 10:55 am staff files were reviewed. Staff Interview: One (1) staff interview conducted.

No citations issued. Exit interview conducted. Copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Lorena Casillas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
LIC809 (FAS) - (06/04)
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