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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881189
Report Date: 01/04/2023
Date Signed: 01/04/2023 01:53:10 PM

Document Has Been Signed on 01/04/2023 01:53 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SPOELSTRA LLC - VOICE LOMA LINDAFACILITY NUMBER:
361881189
ADMINISTRATOR:THOMAS, ELENAFACILITY TYPE:
775
ADDRESS:24733 REDLANDS BLVDTELEPHONE:
(909) 792-2428
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY: 90CENSUS: DATE:
01/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Elena Thomas, AdministratorTIME COMPLETED:
02:15 PM
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Licensing Program Analyst, Amber Coleman (LPA) arrived at the Spolestra, LLA Voice Adult Day Program Facility to conduct an Annual Inspection with a focus on Infection Control. LPA introduced self and stated purpose of the visit. LPA greeted and invited inside by Administrator Elena Thomas. LPA had temperature taken and was asked to sign in. While, signing in LPA discovered the COVID station equipped with PPE, thermometer and hand sanitizer. LPA provided with space to work and then provided walk through with Administrator.

During the inspection, LPA conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures and other health and safety concerns. LPA observed appropriate postings throughout the facility, including hand-washing etiquette, face coverings, and COVID-19 symptoms postings. The facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). Each of 6 restrooms offered appropriate hand soap and paper supplies. LPA observed that the Licensee wearing a mask during the visit. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division (CCLD) guidelines for COVID-19 testing, isolating/quarantining residents, and properly caring for residents with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms. LPA reviewed resident records and interviewed Licensee.

Administrator explained that Stanley Security completes their Fire Drills & Inspections. Last inspection 10/6/22.

Inspection Tool was utilized, Mitigation plan was reviewed. Facility was further inspected, and no deficiencies were noted.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2023
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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