Moreno Beach House of Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with House Manager, Alvin Nene, who was informed of the purpose of the visit. At the time of the visit there was (3) staff and (6) residents present. The facility is a one story home (4) resident bedrooms and (2) resident bathrooms. No pools or firearms are housed at the facility. The facility is approved for (6) non-ambulatory clients. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area had a shaded area and seating, and was free of hazards. LPA observed hygiene supplies for residents, PPE, clean linens. There are designated locked areas for sharps, dangerous objects, cleaning supplies, and medications. The smoke detector and carbon monoxide are operational, and the hot water temperature 109.5F. There are emergency supplies such as emergency lighting and complete first aid kit. A Technical Note was documented for facility to obtain emergency power and kit for emergency items listed on the Emergency Disaster Plan. The emergency exits paths are clear and free of obstructions. LPA observed facility exceeded the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA reviewed the facility's emergency and disaster plan and infectious control plan. Required postings were found in the facility. The listed administrator has a current administrator's certificate. LPA reviewed (3) staff files and (4) resident files. (1) Staff did not have proof during the time of the visit of updated CPR and First Aid training. Resident Files were updated and were complete during the time of the visit. There are no Personal and incidental funds being handled by the facility. Medication Administration Records were audited and medications were accounted for. An exit interview was conducted where this report, along with deficiencies pages, and appeal rights were reviewed and provided.the state’s words, verbatim · CDSS document, May 6, 2026

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: POC

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced Plan of Correction (POC) visit. LPA met with House Manager, Lawrence Santos, who was informed of the purpose of the visit. LPA conducted a walk through, interviews, and records review to verify the POCs from the annual required visit conducted 05/13/2025. The following deficiencies were corrected and cleared during today's POC visit: Deficiency cited under California Code of Regulations (CCR) Title 22 section 87202(a) Fire Clearance for (1) resident who is evaluated as bedridden. The facility does not have a bedridden fire clearance. POC was to call their local fire department and inform them on the bedridden resident in the home. The licensee agreed to issue an eviction notice or apply for a bedridden fire clearance for the (1) resident by the POC due date of 05/14/2025. LPA interview the house manager and reviewed the updated LIC602 for the resident showing they are non ambulatory evaluated 05/21/2025. Therefore, the POC was met and the deficiency was cleared at the time of the visit. Deficiency cited under California Code of Regulations (CCR) Title 22 87411(a) Personnel Requirements - General based on records review, interview, and observation the facility was not sufficiently staff based on (1) resident identified to have wandering behaviors at night and no awake night staff. POC was to submit an LIC500 showing staff coverage awake night staff by the POC due date of 05/16/2025. Record review of LIC500 revealed staffing from the hours of 7:00pm to 7:00am everyday of the week. Therefore, the POC was met and the deficiency was cleared at the time of the visit. Deficiency cited under California Code of Regulations (CCR) Title 22 87633(b) Hospice Care for Terminally Ill Residents for (2) residents on hospice who did not have a copy of their hospice care plan on file. POC was to submit the hospice care plan by the POC due date of 06/13/2025. Record review revealed (1) resident has since been discharged from hospice, and (1) resident has their plan of care on file. Therefore, the POC was met and the deficiency was cleared at the time of the visit. An exit interview was conducted where this report along with Clearance letters, were reviewed and provided to House Manager, Lawrence Santos.the state’s words, verbatim · CDSS document, Jun 2, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced case management visit. LPA met with Staff, Lawrence Santos, and spoke with Licensee Angelica Ubungen over the phone who were informed of the purpose of the visit. LPA conducted record reviews, interview and a walk through. The case management visit was in response to an SOC341 Suspected Dependant Abuse Report for Resident #1 (R1) self reported by the facility. The report stated R1 had been inappropriately touched by Resident #2 (R2) at 12:15am. R1 reported to care staff the following morning around 9:30am on the incident. LPA conducted a tour of the facility. No immediate health or safety issues were observed. LPA attempted but R2 was unavailable for interview. Interview with R1 which revealed incident where R2 inappropriately touched R1. R1 stated staff addressed the issue and reported it and check on her at night. LPA reviewed the staff scheduled showing staff coverage and on call staff at night. LPA conducted interview with (1) over night staff which revealed at 11pm R2 was observed looking at R1, when they returned to their room. Interview with the licensee revealed a meeting was conducted with R2's responsible party and have placed an alarm on R2's door to alert staff if the resident leaves their room. Record review for R1 and R2 revealed their LIC602 Physician's report and care plan did not document R1 or R2 need supervision at night. Based on LPAs interviews and records review there are no health or safety concerns related to the incident report and no deficiencies were cited for the incident. An exit interview was conducted where this report was reviewed and provided.the state’s words, verbatim · CDSS document, May 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with House Manager, Lawrence Santos and spoke with licensee Angelica Ubungen who was informed of the purpose of the visit. At the time of the visit there was (1) staff and (5) residents present. The facility is a one story home with (5) bedrooms and (2) bathrooms for residents. No pool or firearms are present at the facility. The facility is a residential care home for the elderly approved for (6) non-ambulatory residents only. The licensee has submitted dementia care plan. LPA reviewed the resident records, and based on observation of residents the facility has (1) ambulatory resident, (1) bedridden resident, and (3) non ambulatory residents. Bedridden resident is in a room with (1) exit door. Therefore the facility was cited for accepting residents not compatible with the facility's fire clearance. Infection Control: The LPA observed the hand hygiene supplies, PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan. Physical Plant: Physical plant was observed to be clean and fixtures and furniture were in good repair. LPA observed client bedrooms and bathrooms, kitchen, living areas, and outdoor area. The carbon monoxide detector and smoke alarms were functional. The hot water temperature was read at 120F. LPA observed the hazardous items like cleaners and knifes were kept locked and inaccessible to residents. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and safe environment. The facility met the 2-day supply of Perishable and 7-day supply of non-perishable food items. Record Review and Resident/Staff Files: (5) staff records and (5) resident files were reviewed. (2) of (5) residents are receiving hospice services and do not have a hospice care plan on file. Deficiencies were cited for hospice care plans. All staff identified on staff schedules were fingerprint cleared. Health Related Services/ Incidental Medical Services: All resident medication was locked in a hallway closet. Medication was accounted for on the Medication Administration Record (MAR) and observed medications stored in originally received containers. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. The facility exits were observed to be clear of obstructions. An exit interview was conducted where a copy of this report, LIC809-D pages and appeal rights were reviewed and provided.the state’s words, verbatim · CDSS document, May 13, 2025

Type of visit: Case Management - Other

The Department received a notice from the Licensee of a fire clearance change request on 05/13/2024. The Licensee reported the request would be submitted to change the fire clearance from six (6) ambulatory residents to six (6) non-ambulatory residents. An inspection of the facility was completed on the above date. The LPAs inspected the interior and exterior areas of the home. The home appeared to be adequately maintained for the care of non-ambulatory residents. No health and safety concerns were observed at the time of the inspection. An exit interview was conducted and this report was reviewed with Angelica Ubungen, licensee, and a copy was provided.the state’s words, verbatim · CDSS document, Oct 15, 2024

Type of visit: Prelicensing

Licensing Program Analysts (LPAs), Stephanie Martinez, Valerie Flores and Seo Jeong conducted an announced pre-licensing inspection at the home. The LPAs met with Applicants, John Chen and Angelica Ubungen. There are currently no residents in care. Application: The application is for a Residential Care Facility for the Elderly. The fire clearance has been granted for six (6) ambulatory residents. Buildings and Grounds: The home is composed of four (4) resident bedrooms, three (3) bathrooms, one office, a garage, laundry room, living room, an open kitchen and dining area, and front and back yard areas. The interior and exterior walkways of the home were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors were tested and operable. There are no pools or other bodies of water located at the home. According to Chen, there are no weapons stored in the home. Rooms, furniture, beds, mattresses were all in good repair. The bedrooms are furnished, and privacy is available. The dining and living room areas are clutter free and furniture is in good condition. The resident bathrooms were observed to have non-slip mats available. The hot water was tested and measured at 110.4 degrees Fahrenheit, which is within regulatory requirements. Outdoor areas had sufficient room for activities. A washing machine and dryer are available and in working order. Storage and Supplies: Activities were observed to be available. Medications will be stored inaccessible to any unauthorized individuals. Designated areas are available for facility files, staff files and resident files. The first aid kit was observed to be available and complete. Cleaning supplies will be stored away in a locked area. Linens, and equipment are all in good repair and sufficient for approved census. A Fire extinguisher was available and fully charged. Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and stove are in working order. Sharps will be stored in a locked cabinet, available only to authorized individuals. Forms: The following signs were observed to be posted at the home: Theft and Loss Policies, Personal Rights, Resident/Family Councils, and Complaint Information. The following was observed to require follow up: A gate is needed to secure the backyard area, a hole on the side of the outside of the home, which has exposed pipes, needs to be filled in, and extra seating at the dining table needs to be obtained. The LPA will inform the Centralized Applications Bureau (CAB) the home is ready for licensing once proof of corrections are received from the applicants. This report was discussed, and a copy was provided.the state’s words, verbatim · CDSS document, May 9, 2024