Routine inspection·December 23, 2025

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced Required 1 Year visit and met with Administrator (ADM) Ronnie Ubungen and Licensee (LIC) Maybelline Ubungen. LPA stated the purpose of the visit. The facility serves age 60 and over. Five may be non-ambulatory. One may be bedridden. Bedroom #3 and #4 are approved for one bedridden client and hospice waiver for two. LPA observed 6 resident and 3 staff at the time of the inspection. LPA toured the facility including but not limited to the kitchen, dining, activity room, 3 resident room all shared. 1 staff room, garage, bathroom and exterior perimeter. The exterior perimeter and walkway are free from obstruction/debris. The ramp and back deck are maintained, handrails and ramp is sturdy. LPA observed a gazebo in the backyard. Fence was propped up a bougainvillea plant from the neighbor was hanging over the fence, a frayed window screen was observed from the exterior side by the dining area. LPA inspected the kitchen and observed food supply for at least 2 days of perishable food and 7 days of non-perishable food. Sharps and medications were locked in secured areas. Cleaning and laundry supplies are in a separate storage and locked. Resident's bedroom have sufficient storage to store personal items. The bathroom is equipped with grab bars and non-skid floors for adults who are non-ambulatory and ambulatory residents. 1 Out of the 2 bathroom is equipped with a toilet seat riser, and bath bench/chair. page 1 of 2 While inspecting the kitchen drawers LPA observed 4 medications that were not locked and accessible to residents in care. Staff locked the 4 medications expeditiously. The water temperature in 2 bathrooms when measured with a digital thermometer is at 140.9 to 143.7 degree F. The kitchen water sink measured at 145 degree F. The facility room temperature is at 72 degree F. Refrigerator temperature is at 40 degree F and freezer is at 0 degree F. The facility is equipped with a fire alarm system that is in good working condition a fire extinguisher inspected on 05/08/2025. Emergency disaster preparedness was done on 08/5/2025. Fire drill was done on 1/18/25, 4/21/25, 7/17/25 and 10/24/25. A first aid kit complete with the guidebook. LPA gave technical assistance for the earthquake drill resources. LPA Partoza reviewed facility record, 3 staff and 3 residents records such as but not limited to medical assessment (LIC 602A), centrally stored medication and destruction record (CSMDR), appraisal needs and services plan, personal rights, and consent forms. LPA reviewed staff record such as but not limited to training, criminal background clearance, mandated reporting (SOC 341A) and health screening. Deficiencies were cited during today's visit based on California Code of Regulations (CCR) Title 22 87303 (e)(2) and 87465(h)(2) See LIC 809D. An exit interview was conducted with Administrator (ADM) Ronnie Ubungen and Licensee (LIC) Maybelline Ubungen a copy of the report and appeals rights were provided page 2 of 2 end of report