Facility Evaluation Report

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.