Robust Care Home

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 11/19/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Yashmin Ubaldo, who was briefly interviewed at this time. Current census was 4 residents. This facility was vendorized through Valley Mountain Regional Center (VMRC) to be able to accept and retain Level 6 residents at any given time. It was learned that there were (0) residents under the care of hospice at this time. This facility does not have an approved waiver to be able to accept and retain any residents under the care of hospice at any given time. It was learned that this facility does not have a program to be able to accept and retain dementia residents at any given time. It was learned that there was (0) residents diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry area, located in the room next to the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 7009537740, for Yashmin Ubaldo was observed to have an expiration date of 08/27/2026 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility hallway closet , was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguishers were located throughout this facility and observed to have been annually inspected by the local fire extinguisher company, Jorgensen Co, with the inspection date of 07/14/2025 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (4) facility personnel records was conducted and noted on the following LIC 859. A review of (4) facility resident records was conducted and noted on the following LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 19, 2025

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 11/22/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Yashmin Ubaldo, who was briefly interviewed at this time. Current census was 4 residents. This facility was vendorized through Valley Mountain Regional Center (VMRC) to be able to accept and retain Level 4I residents at any given time. It was learned that there were (0) residents under the care of hospice at this time. This facility does not have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility does not have a program to be able to accept and retain dementia residents at any given time. It was learned that there was (0) residents diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry area, located in the room next to the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 7009537740, for Yashmin Ubaldo was observed to have an expiration date of 08/27/2026 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility kitchen closet , was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguishers were located throughout this facility and observed to have been annually inspected by the local fire extinguisher company, Armor Fire, with the inspection date of 07/09/2024 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (5) facility personnel records was conducted on the LIC 859. A review of (4) facility resident records was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 22, 2024

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 11/15/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Yashmin Ubaldo, at this time. A brief interview was conducted with the facility designated Administrator at this time. It was learned that this facility was also vendorized through Valley Mountain Regional Center (VMRC) to be able to accept and retain up to (4) Level 4I residents at any given time. Current census was 4 residents. There were no residents under the care of hospice or home health at this time according to statements made by the facility designated Administrator. Tour of this facility was conducted. A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time. Cleaning agents, bleach, and other supplies were observed to be locked and made inaccessible to the residents at this time. A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility staff at this time. A review of the facility Medication Administration Record and dispensing log was conducted. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. Living room, dining area, and all other areas intended for resident use were observed to furnished and maintained in compliance at this time and able to meet the needs of the residents. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident restrooms was conducted. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they measured within the allowed range of 105-120 degrees at all times. Laundry room was observed to be unlocked but did not house any detergents, soaps, or bleach at this time. It was learned that all cleaning and laundry supplies were separately locked and made inaccessible to the residents at all times. Linen closet was reviewed. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the garage area was conducted. Additional food storage units were observed to be present and in good repair at this time. Additional nonperishable food supplies were observed to be present along with emergency food supplies as well. First aid kits were observed to be present and contained all of the required components at this time. Fire extinguishers were observed to be placed throughout this facility and were inspected by the local fire authority, Armor Fire, on 07/12/2023 and found to be in compliance at this time. A tour of the exterior grounds for this facility was conducted. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (4) resident files was conducted and noted on the LIC 858. A review of (4) resident staff files was conducted and noted on the LIC 859. The following forms and documents were requested to be updated and submitted into CCL in order to update this facility file: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 15, 2023

Type of visit: Post Licensing

Unannounced post licensing visit made out to this facility on 11/15/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Yashmin Ubaldo, at this time. A brief interview was conducted with the facility designated Administrator at this time. It was learned that this facility was also vendorized through Valley Mountain Regional Center (VMRC) to be able to accept and retain up to (4) Level 4I residents at any given time. Current census was 4 residents. There were no residents under the care of hospice or home health at this time according to statements made by the facility designated Administrator. Tour of this facility was conducted. This post licensing visit was conducted in conjunction with the annual visit. All file reviews for the facility staff and residents were conducted per the annual visit. There were no deficiencies observed or cited during today's post licensing visit. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 15, 2023