Routine inspection·December 17, 2025

On 12/17/2025 at 12:08PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Kenneth David, Caregiver and explained the purpose of the visit. Kenneth contacted Marivic Datuin, Administrator to advise of visit. Administrator gave authorization for Kenneth to sign report. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden resident. LPA toured facility with Kenneth including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of six (6) bedrooms, three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 80 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 109.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2 days of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last purchased on 11/07/2025. First aid kit was observed to be complete. Fire drill was last conducted on 10/10/2025. Emergency disaster plan last updated 10/10/2025. Continues on LIC809C.... Continued from LIC809. Five (5) staff records were reviewed; all five (5) staff have FirstAid/CPR and were associated. LPA also reviewed all six (6) resident records, and they were complete. LPA requested the following documents to be submitted to CCLD by 12/24/2025 LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Updated Facility Sketch LPA observed no deficiencies during visit. Exit interview conducted a copy of this report provided.