Routine inspection·December 6, 2024

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with administrator (ADM) Ronnie Ubungen . LPA observed 5 residents and 2 staff at facility. LPA reviewed 3 resident files and 3 staff files. 2 Out of 3 resident files were observed that centrally stored medication forms were not matched with their medications. Facility license, Administrator Certificate, and personal right posters were observed at main entrance. LPA toured the facility with ADM inside and out. LPA inspected living room, family room, dinning area, kitchen. There are 2 restrooms, 1 staff live-in room, 3 resident rooms in facility. Grab bars and non slipping resisted floor were observed at the restrooms. Two days perishable foods and seven days non perishable foods were observed sufficient. Room temperature was observed at 68 degree F, hot water temperature was observed at 119 degree F. Temperature of refrigerator was measured at 45 degree F, and temperature of freezer was observed at 0 degree F. Medication cabinet, Knives closet and cleaning products closet were observed locked. Fire extinguisher was serviced on 5/21/2024. The facility is equipped with fire alarm and carbon monoxide detectors. Smoke detector alarm system was tested, and was working fine. First Aide Box, night lights and emergency flash lights were observed. Front yard and backyard were inspected. There was no obstruction to block the walkways. Facility last fire and emergency drill was conducted on 10/20/2024. Citation was issued today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.