Routine inspection·January 28, 2026

Licensing Program Analyst (LPA) Correia conducted the required one-year inspection. Upon arrival, LPA was greeted by Caregiver Mabenilda Rumingan, identified herself, and explained the purpose of the visit. The facility is licensed to serve six (6) residents aged 60 and above, all of whom may be non-ambulatory and/or receiving hospice services, and up to two (2) residents who may be bedridden. Licensee Hideen Nucom arrived shortly thereafter to join the inspection. The facility’s census at the time of inspection was five (5) residents in care: four (4) non-ambulatory, one (1) receiving hospice services, and one (1) bedridden. All five residents were present during the visit. A review of resident files confirmed that all required documents including the current Physician’s Report, Resident Appraisal, Needs & Services Plan, Identification and Emergency Information, and Admission Agreement, were complete and up to date. Staff files were reviewed and found to include Criminal Record Clearance, required training, Health/TB Screening Report, First Aid and CPR certification, and qualifications. All records were current and complete. The Administrator’s certification is valid until 2027. The facility’s last disaster drill was conducted in December of 2025. The Licensee owns the property and maintains current liability insurance. [Continued on LIC 809C] Medications and Hazardous Materials: Medication administration records were accurate and complete. Medications were stored in a locked medication cart located in the staff office. Toxic substances and other hazardous materials were secured in locked cabinets and were inaccessible to residents. Facility Tour: LPA, accompanied by Licensee Nucom, conducted a tour of the interior and exterior of the facility. The facility was observed to be clean, sanitary, and in good repair. Pathways were free of obstructions and slip hazards. Required postings were visible. Resident bedrooms contained the required furnishings. Resident showers were equipped with non-skid flooring and grab bars and were in working order. Water temperature at taps used by residents measured 105.1°F. Doors, windows, and screens were in good condition. Extra linens, hygiene supplies, Personal Protective Equipment (PPE), and a landline telephone were available. Smoke and carbon monoxide detectors were present and operational. Fire extinguishers were up to date on inspections, and a stocked First Aid Kit was available. The facility has a large common area and a shaded outdoor space for activities and visitation. No bodies of water were observed on the premises. Per the Licensee, there are no firearms or ammunition on the property. Based on today’s inspection, no deficiencies were cited. An exit interview was conducted, and a copy of this report along with Licensee Rights (LIC 9058, rev. 01/16) will be provided to Licensee Nucom. Licensee’s signature on this form acknowledges receipt of these documents.