Facility Evaluation Report

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.