Los Osos Residential Care II

Type of visit: Required - 1 Year

At 8:30am on 07/21/2026, Licensing Program Analyst (LPA) Jeffries arrived unannounced to conduct this facility annual inspection. LPA met with Administrators Amilio & Marilou Ubay, announced who he is and the reason for the visit. Administrators and LPA conducted a physical tour of the facility. This facility is a 5 bedroom, 3 bathroom, 1 living room, kitchen with large island and a dining room. There is a fenced back yard with table, chairs and umbrella for shade for clients, visitors, staff to use for outdoor activities and visitations. LPA observed residents rooms to have proper linins and furniture per regulation standards, LPA observed bathrooms to have liquid soap and paper towels. LPA checked facility water temperature to be within regulation standards of 105*-120*(f). LPA noted that each room has a hardwire smoke detector and the carbon monoxide detector is located above the refrigerator in the kitchen. LPA noted that the medications are locked in a cabinet in the kitchen area and there is a completed 1st Aide kit per regulations also in the medication cabinet. LPA observed two fire extinguishers both primed and in the green reading. LPA observed at least two days of perishable foods and at least seven days of non perishable foods on hand for at least six residents and staff. LPA noted that emergency water in more than sufficient quantities located in the facility garage. LPA noted that the facility was clean and in good repair and all hallways, and exits were free from obstructions. LPA reviewed documentation of Emergency Disaster Plan, Infection Control Plan, Liability Insurance, Staff and Client files, Centrally Stored Medication Record (CSMR) all to be complete, up to date and in regulations compliance. Administrators and LPA conducted full review of annual care tools. LPA noted that there were no violations or citations as a result of this annual facility inspection. EXIT INTERVIEW, REPORT READ, AND REPORT PROVIDED.the state’s words, verbatim · CDSS document, Jul 21, 2026

Type of visit: Required - 1 Year

At 7:30am on 06/19/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to conduct this facility annual inspection. LPA met with Administrators Amilio & Marilou Ubay, announced who he is and the reason for the visit. Administrators and LPA conducted a physical tour of the facility. This facility is a 5 bedroom, 3 bathroom, 1 living room, kitchen with large island and a dining room. There is a fenced back yard with table, chairs and umbrella for shade for clients, visitors, staff to use for outdoor activities and visitations. LPA observed residents rooms to have proper linins and furniture per regulation standards, LPA observed bathrooms to have liquid soap and paper towels. LPA checked facility water temperature to be within regulation standards of 105*-120*(f). LPA noted that each room has a hardwire smoke detector and the carbon monoxide detector is located above the refrigerator in the kitchen. LPA noted that the medications are locked in a cabinet in the kitchen area and there is a completed 1st Aide kit per regulations also in the medication cabinet. LPA observed two fire extinguishers both primed and in the green reading. LPA observed at least two days of perishable foods and at least seven days of non perishable foods on hand for at least six residents and staff. LPA noted that emergency water in more than sufficient quantities located in the facility garage. LPA noted that the facility was clean and in good repair and all hallways, and exits were free from obstructions. LPA reviewed documentation of Emergency Disaster Plan, Infection Control Plan, Liability Insurance, Staff and Client files, Centrally Stored Medication Record (CSMR) all to be complete, upto date and in regulations compliance. Administrators and LPA conducted full review of annual care tools. LPA noted that there were no violations or citations as a result of this annual facility inspection. EXIT INTERVIEW, REPORT READ, AND REPORT PROVIDED.the state’s words, verbatim · CDSS document, Jun 19, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 9:25 am to conduct a 1-year annual visit to the facility above. LPA met Administrator Amilio & Marilou Ubay and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has submitted a current Mitigation Plan, Infection Control Plan, Emergency Disaster Plan and provided plans to the department. The facility has a sign in and out clipboard for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30-day supply of PPE. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and waste baskets have tight fitting covers. Physical Plant & Environment Safety: The facility has 5 bedrooms and 3 bathrooms currently occupying 5 residents and employs 4 staff with 1 live in staff. The facility is clean, safe, and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors, both were tested and working at time of visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe, and sanitary. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Continued 809-C Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in garage. The facility has sufficient space inside and outside for activities and visiting. The facility has an enclosed backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Operational Requirements: The facility has a current plan of operation and infection control plan on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 07/01/2025. The facility is approved for a capacity of 6 non-Ambulatory. Staffing: The facility employes 2 staff and 2 Administrators. Staff records are kept confidential. LPA reviewed 2 staff files and all required documents were present. Personnel Records & Training: The facility keeps confidential files for each staff member. All staff had current 1st AID/CPR. Staff had 20 plus hours of training for 2024 not all topics were covered LPA provided training requirements to complete for 2024 to meet all annual training requirements. Administrator Certificate expire on 09/27/2025 and other certificate has been completed and submitted but is delayed at the state level. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Three files were reviewed for signed Admission Agreements, Medical Assessments LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. The Facility does not handle cash resources for any of the residents in care. Facility does submit incident reports to the department when required. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored, and marked appropriately. Continued 809-C Food, snacks, and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin, and insects. Kitchen staff are observed for personal hygiene and food sanitation practices. Health Related Services: First Aid is provided to residents in care. Staff has current 1st Aid/CPR certificates on file. Facility provides Centrally Stored Medications to all residents in care. Clients’ medication records were reviewed, prescriptions had doctors’ orders, and PRN medications were checked for expiration. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). Facility provides transportation to medical and dental appointments when needed. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drill last one was in 04/2024. The fire extinguishers were charged and had a receipt for the date of purchase with in the last year. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Jul 3, 2024