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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609745
Report Date: 03/07/2022
Date Signed: 03/07/2022 01:17:33 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/07/2022 01:17 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:GROWTH EXTENDED INCFACILITY NUMBER:
197609745
ADMINISTRATOR:LEWIS, JOYFACILITY TYPE:
772
ADDRESS:15743 COVELLO STTELEPHONE:
(888) 549-8884
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 0DATE:
03/07/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Joy Lewis - Administrator TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced continuance of an Annual Inspection and Infection Control Inspection visit to the facility.LPA continued the annual visit due from the inspection conducted on 2/28/2022. Upon arrival LPA met with Licensee Joy Lewis and John Lewis explained the reason for the visit.

The facility site is in a two story single family home.

KITCHEN: The kitchen, located on the ground floor included fixtures and both kitchen and laundry appliances that appeared clean and functional and were in new condition. There was sufficient nonperishable food in supply to accommodate a maximum capacity of six (6) adults for one week.

BEDROOMS: There are three bedrooms all located on the ground floor designated for client use, all furnished for double occupancy. All required furniture, bedding and linens were observed. There were no visible hazards.

BATHROOMS: There are nine (9) Bathrooms. Four (4) half baths and five (5) full baths. The half bath attached to the kitchen is designated for staff use only. All other bathrooms are designated for client use. All bathrooms had functional fixtures and had required supplies.

COMMON AREAS: The common areas on the ground floor include the combination dining area and living room, a second living area in the rear of the house and a yoga/exercise room. The common areas on the second floor include two (2) living/sitting rooms and a fully equipped theater. The common areas on the
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2022
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GROWTH EXTENDED INC
FACILITY NUMBER: 197609745
VISIT DATE: 03/07/2022
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second floor also house four (4) pet cats that are used as pet/animal therapy. All common areas are furnished to adequately accommodate a maximum capacity of six (6) adults. There were no visible immediate hazards.

STAFF/OFFICE AREAS: The office areas are located on the ground floor. There are two offices used for individual therapy sessions, one office used for staff and include the medication and record storage. There is a large conference style office area used for group sessions. Medications will be stored in a locked medication cart and secured with a padlock. The padlock key is stored in a combination lock box attached to the interior wall.

SURROUNDING GROUNDS: The front yard has lawn and garden areas. There was a small storage shed located in the back yard area, LPA observed it to store old furniture at this time. There is a nearby park that will be used for outdoor activities.

The LPA spoke with Joy Lewis regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate each bedroom as a single isolation room if the facility has a confirmed case of COVID-19. COVID-19 testing will be conducted weekly if anyone shows any symptoms. The facility’s policies and procedures as it pertains to infection control are adequate at this time.


No deficiencies cited. Exit interview conducted. A copy of the report was issued and sent via email.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
LIC809 (FAS) - (06/04)
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