Routine inspection·May 13, 2025

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with House Manager, Lawrence Santos and spoke with licensee Angelica Ubungen who was informed of the purpose of the visit. At the time of the visit there was (1) staff and (5) residents present. The facility is a one story home with (5) bedrooms and (2) bathrooms for residents. No pool or firearms are present at the facility. The facility is a residential care home for the elderly approved for (6) non-ambulatory residents only. The licensee has submitted dementia care plan. LPA reviewed the resident records, and based on observation of residents the facility has (1) ambulatory resident, (1) bedridden resident, and (3) non ambulatory residents. Bedridden resident is in a room with (1) exit door. Therefore the facility was cited for accepting residents not compatible with the facility's fire clearance. Infection Control: The LPA observed the hand hygiene supplies, PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan. Physical Plant: Physical plant was observed to be clean and fixtures and furniture were in good repair. LPA observed client bedrooms and bathrooms, kitchen, living areas, and outdoor area. The carbon monoxide detector and smoke alarms were functional. The hot water temperature was read at 120F. LPA observed the hazardous items like cleaners and knifes were kept locked and inaccessible to residents. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and safe environment. The facility met the 2-day supply of Perishable and 7-day supply of non-perishable food items. Record Review and Resident/Staff Files: (5) staff records and (5) resident files were reviewed. (2) of (5) residents are receiving hospice services and do not have a hospice care plan on file. Deficiencies were cited for hospice care plans. All staff identified on staff schedules were fingerprint cleared. Health Related Services/ Incidental Medical Services: All resident medication was locked in a hallway closet. Medication was accounted for on the Medication Administration Record (MAR) and observed medications stored in originally received containers. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. The facility exits were observed to be clear of obstructions. An exit interview was conducted where a copy of this report, LIC809-D pages and appeal rights were reviewed and provided.