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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800437
Report Date: 09/26/2022
Date Signed: 09/26/2022 02:42:59 PM

Document Has Been Signed on 09/26/2022 02:42 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:LOAFER'S LANDING ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
331800437
ADMINISTRATOR:PENDINGFACILITY TYPE:
735
ADDRESS:5656 CHERYL STREETTELEPHONE:
(951) 357-2244
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 4CENSUS: 4DATE:
09/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Aloaf Walker - AdministratorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with Administrator Aloaf Walker and advised them of the purpose of the visit, and that the Annual Inspection will be focused on Infection Control only. Below is a summary of what was observed:

Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator Aloaf Walker, who LPA Colvin found to be successfully incorporating the several aspects of the facility's Mitigation Plan. LPA Colvin observed that Licensing does not have a copy of the Mitigation/Infection Control Plan on file, and requested that the Licensee fax it in. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap and paper towels. While touring the facility, LPA Colvin observed postings throughout the facility for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns) which LPA Colvin observed to be sufficient for a 30-day supply. LPA Colvin went over the various recommended training for facility staff with Administrator Aloaf Walker in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE.

LPA Colvin inquired as to if staff have been fit tested for N95 masks, and Administrator Aloaf Walker confirmed that they have conducted fit testing for all staff. LPA Colvin was informed that all staff are vaccinated, so staff are not required to test weekly. In addition to going over the facility's policy for testing staff and residents for COVID-19, LPA Colvin also inquired about if the facility is still screening their residents daily for COVID-19 symptoms, which includes checking their temperature. Administrator Aloaf Walker confirmed that staff are continuing to monitor residents’ symptoms, and that both staff and visitors are screened for COVID-19 symptoms prior to entering the facility. LPA Colvin additionally observed a sign-in log for visitors, where their temperature is recorded as well as answers to screening questions.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: LOAFER'S LANDING ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 331800437
VISIT DATE: 09/26/2022
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Throughout LPA Colvin's inspection, LPA Colvin observed that Administrator Aloaf Walker was not wearing a face covering of any kind. LPA Colvin informed Administrator Aloaf Walker that at this time, Long Term Care Facilities (such as this facility) are still advised to have all staff and visitors wear a face covering at all times when inside the facility. LPA Colvin will be issuing a Technical Assistance (TA) Advisory Note at this time. Additionally, LPA Colvin recommended for the facility to have signs posted outside on the front door advising visitors to not come in if they have any symptoms of COVID-19, and that masks are required.

An exit interview was conducted with Administrator Aloaf Walker were a copy of this report and LIC9102 TA Advisory Note was provided.


*Note signature obtained via email as report was amended to correct mistake regarding citation issued. No citations issued during inspection. Amended report was emailed to facility and signature was obtained*
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC809 (FAS) - (06/04)
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