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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609745
Report Date: 02/25/2025
Date Signed: 02/25/2025 01:59:43 PM

Document Has Been Signed on 02/25/2025 01:59 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:GROWTH EXTENDED INCFACILITY NUMBER:
197609745
ADMINISTRATOR/
DIRECTOR:		LEWIS, JOYFACILITY TYPE:
772
ADDRESS:15743 COVELLO STTELEPHONE:
(888) 549-8884
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 0DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:47 AM
MET WITH:Joy LewisTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:02 AM. LPA spoke with facility staff via telephone call who contacted the facility administrator Joy Lewis. The Administrator arrived to the facility at 11:47 AM. Entrance interview conducted and the reason for the visit was explained. The Administrator informed LPA that the facility does not currently have any clients admitted.

Beginning at 11:48 AM, the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: There are three (3) bedrooms in the facility. All bedrooms are located on the ground floor and are designated for client use. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom number three (3) was observed to contain a direct exit to the outside of the facility.

BATHROOMS: There are nine (9) Bathrooms located in the facility. LPA observed four (4) half baths and five (5) full baths. LPA observed one (1) bathroom to be designated as a private resident bathroom attached to bedroom #2. Grab bars were observed in resident showers and near resident toilets, all grab bars observed were properly secured. The water temperature was measured between 67.5 and 68 degrees Fahrenheit, which is outside of the range required by regulation. One (1) upstairs bathroom sink was observed to lack hot water flow completely. Additionally, LPA observed this bathroom to be unclean and in an un-sanitary state.

KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. LPA observed the refrigerator/freezer to be in operable condition and maintained at an appropriate temperature for food storage. Continued on LIC 809C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GROWTH EXTENDED INC
FACILITY NUMBER: 197609745
VISIT DATE: 02/25/2025
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COMMON AREAS: The common areas on the ground floor include the dining area / living room, a second living area in the rear of the home, and an exercise room. The common areas on the second floor include two (2) living rooms and a fully equipped theater. All common areas are furnished to adequately accommodate a maximum capacity of six (6) adults. LPA observed three (3) fire alarms to be chirping throughout the visit. The facility’s combination fire and carbon monoxide detectors were tested at 12:12 PM and were functional at the time of the visit. LPA observed cameras located throughout the facility’s common areas.

STAFF/OFFICE AREAS: LPA observed three (3) office areas located on the ground floor of the facility. LPA observed office #1’s screen door to contain a rip in the screening material. LPA observed the floor near the exit to the outside of the facility in office #2 to be in disrepair. LPA observed office #3 to contain a locked medication cart secured with a padlock and activities for resident use. Additionally, LPA observed office #3 to smell of mildew and the wall to be in disrepair. LPA observed a large conference style office area used for group sessions attached to office #3. Office #3 contained a first aid kit that contained all required materials.



SURROUNDING GROUNDS: LPA observed the outdoors of the facility to contain cameras. LPA observed one (1) ramp to be detached from an exit to the facility located in the exercise room. Additionally, LPA observed a wooden stairwell attached to the second floor of the facility to be in disrepair with loose railings.

RECORD REVIEW: Record review began at approximately 01:00 PM. No resident records were reviewed. One (1) staff file was available for LPA to review as the remaining staff files were not stored at the facility. The staff file reviewed contained all required documentation and signatures.

MEDICATION REVIEW: Medication review was not conducted as no clients currently reside at the facility.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the
facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. The facility’s emergency disaster plan is complete and is adequate.

Continued on LIC 809C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GROWTH EXTENDED INC
FACILITY NUMBER: 197609745
VISIT DATE: 02/25/2025
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INTERVIEWS: No interviews were conducted at the time of the inspection.

As there are no clients residing at the facility no deficiencies were cited during today’s inspection. LPA informed Administrator that all required corrections must be completed prior to accepting clients into care. Administrator confirmed that corrections will be made and that they will notify CCLD once they accept clients into care. This report was reviewed with the Administrator, a copy of the report was issued and exit interview was conducted.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC809 (FAS) - (06/04)
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