197609745-2-24-2023-29-AS-BBAI-CPCQC9-20230224110245

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609745
Report Date: 02/24/2023
Date Signed: 02/24/2023 11:02:52 AM

Document Has Been Signed on 02/24/2023 11:02 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	GROWTH EXTENDED INC		FACILITY NUMBER:	197609745
ADMINISTRATOR:	LEWIS, JOY		FACILITY TYPE:	772
ADDRESS:	15743 COVELLO ST		TELEPHONE:	(888) 549-8884
CITY:	LAKE BALBOA	STATE: CA	ZIP CODE:	91406
CAPACITY: 6		CENSUS: 0	DATE:	02/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Joy Lewis - Administrator		TIME COMPLETED:	11:30 AM

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	Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual. This annual had a specific emphasis on infection control practices and procedures. Upon arrival LPA met with Administrator Joy Lewis and explained the reason for the visit. There were no clients at the time of the visit. The facility operates as a Social Rehabilitation Facility, Short Term Crisis Residential Treatment Program with a maximum capacity of 6 ambulatory adults. The site is in a two story single family home. A tour of the physical plant was initiated at approximately 9am and the following was observed: Kitchen: LPA observed Kitchen to be clean and the appliances and fixtures functional. Kitchen knives were observed to be inaccessible. Stove burners are rendered inaccessible to the residents by installing a lock when not in use. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0F) and the refrigerator was maintained at 40F. Nonperishable food was observed to be adequate and properly stored. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in office storage area. No flies or other vermin were observed. There are (3) shared bedrooms total. All bedrooms for clients use were properly furnished and had appropriate bedding and linens. There were (9) bathrooms total. (4) half baths and (5) full baths. The half bath attached to the kitchen is designated for staff use only. The resident bathroom(s) have a shower with non-skid materials. All bathrooms had functional fixtures and had required supplies. The hot water temperature was tested in the bathrooms and the kitchen was found to be within the range of 105F and 114F. Continued on 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

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: 02/24/2023

NARRATIVE

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Continued from 809

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 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 are to 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 exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. The entire property is not fenced. The back and sides of the house are separated from the front yard by a gate at the east side passageways. There are no bodies of water on the premises at the present time.

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 and report issued to Administrator.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC809 (FAS) - (06/04)

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