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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200574
Report Date: 01/28/2025
Date Signed: 01/28/2025 12:50:19 PM

Document Has Been Signed on 01/28/2025 12:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ABSOLUTE CARE FOR LIFEFACILITY NUMBER:
079200574
ADMINISTRATOR/
DIRECTOR:		LEVIN, EMCY MADRIAGAFACILITY TYPE:
740
ADDRESS:1700 MARLESTA ROADTELEPHONE:
(510) 478-8926
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Gloryciel Cavanting CaregiverTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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On 1/28/2025 at 9:45 am, Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-Year Required inspection. LPA met with Gloryciel Cavanting Caregiver, and explained the purpose of the visit. Emcy Levin, Administrator arrived at 10:50 am. The Administrator currently holds a certificate (#7003792740) that expired on 03/16/2026. The facility’s fire clearance was approved for three (3) ambulatory and three (3) non-ambulatory residents.

LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of five (5) total bedrooms and three (3) bathrooms. No bodies of water observed. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 109 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 04/09/2024. Emergency Disaster Plan was posted. First aid kit was observed to be complete. Earthquake and fire drill last conducted on 12/05/2024.

LPA reviewed four (4) resident files and three (3) staff files all complete.

CONTINUE ON LIC809C.
Bennett FongTELEPHONE: (510) -62-2621
Carol FowlerTELEPHONE: (510) 622-2715
DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ABSOLUTE CARE FOR LIFE
FACILITY NUMBER: 079200574
VISIT DATE: 01/28/2025
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continue from LIC 809

LPA requested the following documents to be submitted to CCLD by 2/07/2025.

· Resident Roster
· LIC 308 Designation of Administrative Responsibility
· LIC 309 Administrative Organization
· LIC 500 Personnel Report
· LIC 610E Emergency Disaster Plan (9 pages)
· Liability Insurance

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol FowlerTELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC809 (FAS) - (06/04)
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