Routine inspection·July 29, 2025

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required - 1 year annual inspection. LPA met with Administrator/Licensee, Ronnie Ubungen and Maybelline Ubungen. During visit, LPA toured the facility with staff to include the living room, kitchen, resident bedrooms, bathrooms, garage, laundry room, and backyard. All fire exit routes were free and clear of obstruction. LPA observed 2 residents watching TV in the living room and 3 residents in their bedrooms. Facility is retaining 1 resident under hospice care. 3 staff members present are fingerprint cleared and associated to the facility. Facility temperature maintained at 75 degrees F. Fire extinguisher last serviced on 05/08/2025. Facility has an operable carbon monoxide detector. Facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. Refrigerator temperature maintained at 38 degrees F. Freezer temperature maintained at 0 degrees F. Hot water temperature was measured at 2 out of 2 bathrooms, which measured between 115.7 - 118 degrees F. Resident bedrooms equipped with proper furniture, linens, and adequate lighting. LPA observed 4 resident beds were equipped with bed rails - 1 resident had full bed rails and 3 residents had half bed rails. The Licensee did not have the physician's order for 4 out of 4 residents. See LIC809-C. LPA observed 1 resident who based on their physician's report is bedridden, but was residing in a room that is not approved for a bedridden resident based on the facility's fire clearance. Licensee will first talk with the family and states a plan to possibly move the resident to the master bedroom which is approved for bedridden resident, to comply with their fire clearance. LPA reviewed 3 resident files. Based on record review, 2 out of 3 appraisal/needs and services plan (ANS) were updated annually. LPA observed 1 out of 3 resident's reappraisal was not updated annually and the last reappraisal was dated on 08/08/2023. LPA reviewed a total of 5 resident's physician's report and observed 4 out of 5 physician's report was updated within the year. 1 out of 5 resident's who is diagnosed with dementia physician's report was last updated in year 2023. All other required items to include the admission agreement, TB result, consent forms, personal rights, identification/emergency contact information, and safeguard forms were included in the 3 resident files. LPA reviewed 3 staff files. 3 out of 3 staff has a fingerprint clearance, health screening, TB result, job application and active first aid certification. 2 out of 3 staff members has not completed at least 20 hours of annual training on dementia care. Facility has an emergency disaster plan. Fire drills are being completed quarterly and the last drill was completed in July 2025. LPA recommended Licensee to also include earthquake drills. Facility has emergency supplies to include extra flashlights, batteries and first aid kit. Facility has an infection control plan. Personal Protective Equipment observed to include gloves, hand sanitizer, gowns and lidded trash bins. Deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensee/Administrator Ronnie Ubungen and a copy of the report and appeal rights were provided.