Routine inspection·October 15, 2025

On 10/15/2025, Licensing Program Analyst (LPA) Vado Jaime Vado conducted an unannounced annual required inspection visit. LPA met with administrator Rommel Dionson and explained the purpose of today's visit. There is one resident present and the remaining 4 are at day program. Currently there are 4 staff present in the facility and the administrator. This is a single level facility licensed for residents age range 60 and over. Approved for 6 non-ambulatory. One client is using oxygen. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. There are no video cameras on inside the facility per the administrator. LPA observed the facility kitchen which is clean and observed appliances that are in good repair. Knives are stored and locked in a drawer adjacent to the kitchen sink. Perishable and non-perishable food items are observed as in place. There is an additional refrigerator and freezer in the garage area which carries additional food supplies for resident use. Multiple bins are observed storing emergency food supplies such as canned foods and juices. This can be incorporated into facility resident meals as well. First aid kit is observed as complete with required items. Medications are observed to be locked in a credenza located outside of the kitchen. LPA observed at least two fire extinguishers in place which are currently within operating range with inspection tags of 04/17/2025, smoke detector, carbon monoxide detectors are observed in place through out the facility, and central heating. Facility is equipped with fire sprinklers through out. PPE is observed to be in place and additional supplies are observed in a shed in the backyard. Laundry area is also observed as fully operational in the garage. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted on 10/01/2025. Water temperature was measured at 105F in both resident bathrooms observed. One is a full walk in shower room. Continued on next... Page 2 LPA observed all resident rooms as clean, free of odors, and contained all the required furniture per regulatory recommendations. Extra resident linen supplies are observed as in place in hallway closet and in resident room closets. Resident bathroom is observed as clean and in good worker order. Shower floors are equipped with non-skid mats. Facility does handle resident monies and is current as it is reviewed with staff. Per inspection medications and logs are observed today as current. During today's inspection, LPA reviewed 5 resident files which are current. And 4 staff files which are current. Administrator certificate is observed as current expiring on 03/02/2027. The following updated forms are requested to be submitted to CCLD by 10/22/2025 : • Copy of updated administrator certificate • Copy of facility's liability insurance • Copy of facility surety bond • Copy of current LIC610E • LIC308 Designation of responsible staff person • LIC500 Staff Schedule No citations issued. Report is reviewed with Rommel and a copy is provided on this day.