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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530074
Report Date: 01/17/2023
Date Signed: 01/17/2023 11:20:47 AM

Document Has Been Signed on 01/17/2023 11:20 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ALOHA SENIOR LIVING LLCFACILITY NUMBER:
365530074
ADMINISTRATOR:HAMILTON, CAROL KANANIFACILITY TYPE:
740
ADDRESS:8880 TANGERINE AVENUETELEPHONE:
(714) 323-8445
CITY:HEPERIASTATE: CAZIP CODE:
92345
CAPACITY: 4CENSUS: DATE:
01/17/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Hamilton, AdministratorTIME COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analyst, Amber Coleman (LPA) arrived at the Aloha Senior Living Facility for an announced Case Management visit to follow up regarding the pool gate and its security. LPA introduced self and stated the purpose of the visit. Administrator Carol Hamilton greeted LPA and granted entry into facility. LPA was provided a space to work and set up. Jennifer Nelson, prospective Co-Administrator was also present during visit.

Administrator showed to the backyard area for inspection of the pool and changes made to make the gate more secure as requested. LPA observed that the mesh gate had been removed altogether and replaced with a chain link fence. The fence was measured at 5ft in height. Administrator explained that the company who installed this gate describes this gate as a "pool code" gate meaning that the gate itself deters people from climbing it by making the chain links smaller. The gate is made secure by latches on the door and placement for a lock. LPA expressed concern with the space between the top of the gate and the oning. LPA advised Administrator to remove all standing furniture away from the fence as to discourage climbing of the gate. LPA also advised that more consideration will be needed to confirm the gate is secure enough and that changes made are sufficient. LPA took photos of the new gate for consultation and to be discussed with Licensing Program Manager. LPA and Administrator further discussed licensing process and coordinated follow up, then concluded the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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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