CCLD received an application on February 3, 2026. The initial license application was for a Residential Facility for the Elderly, serving individuals aged 60 and above. The applicant requested a capacity of (5) non-ambulatory, of which (1) may be bedridden for Bedroom #2. Bedrooms #1, #3, and #4 approved for non-ambulatory.

Structure:

The facility consists of (4) resident bedrooms and (3) resident bathrooms. The facility is situated in a residential neighborhood. The facility has its kitchen, living room, dining room, outdoor patio area, and laundry room in the garage. The passageways, walkways, and steps are free from obstructions.

Resident's Bedroom:

The facility had four (4) rooms with (6) twin-size beds, one (1) chair, one (1) nightstand, one (1) dresser, and one (1) table lamp. All rooms had ample storage in the closets. The facility allows residents to either furnish their rooms with their own furniture or utilize furniture provided by the licensee.

Bathrooms:

Each unit has a bathroom. All bathrooms have a working toilet, washbasin, and shower with grab bars.

(Evaluation Report Continues LIC 90969-C)

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Beds have the required linens and supplies, including pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. The facility also provides linen and furnishings for residents who may require their own, as well as hygiene supplies.

Emergency Phone Numbers, Exit Plan & Menu:

Emergency phone numbers, exit plan, and menu are posted and readily available for review throughout the facility. There are three fire extinguishers in the kitchen, the dining room, the garage, and they are fully charged. All rooms have a telephone line available and internet services. All exit doors have sensors.

Food Service:

Dishes, cups, and flatware are stored in the kitchen, inspected, and in good condition. Knives, cutlery, and other sharp kitchen utensils are stored in kitchen drawers. Food is stored properly in the kitchen and includes both perishable and non-perishable items.

Smoke Detectors:

Smoke and carbon monoxide detectors throughout the interior. Hardwired smoke detectors throughout the common areas and in each resident’s room. Carbon monoxide detectors in each resident’s room. The facility is equipped with central air and heat throughout the facility.

Water Temperature:

The water temperature ranged from 105.0 degrees F. throughout the kitchen and bathrooms.

Toxins:

All toxins are stored in storage closets underneath the kitchen cabinet and the garage cabinets.

(Evaluation Report Continues LIC 90969-C)

The facility had gas stove burners, a microwave, a washer, and a dryer. The kitchen also had small appliances, which included a rice cooker and an air fryer. There are two refrigerators in the kitchen and the other in the garage. The refrigerator maintains a temperature of at least 45 degrees Fahrenheit for proper food storage. A freezer is at 45 degrees Fahrenheit.

Medications, First-Aid Kit & Book:

Several first aid kits are available and stored at the kitchen cabinet. They have at least the following: a thermometer, tweezers, scissors, antiseptic, bandages, gauze, and a current first-aid manual. The residents’ medications will be stored in the kitchen cabinets.

Resident & Staff Files:

Records for staff and residents are stored in the kitchen cabinets.

Reading Material, Games, Equipment & Materials:

The facility has board games, books, magazines, and other recreational materials for resident use, stored in the hallway table.

Pool/Jacuzzi & Pets:

No jacuzzi or pool in the area. The Admission Agreement or Plan of Operation did not include the acceptance of pets.

Fire clearance:

A Fire Clearance inspection was conducted on February 27, 2026, with approval for a capacity of (5) non-ambulatory and (1) for bedridden.

Security:

Currently, the facility does not have interior surveillance cameras in common areas.

(Evaluation Report continues LIC 9099-C)

(LPA) Dabuet conducted the pre-licensing inspection and provided information on how to operate the facility in substantial compliance with Component III.

An exit interview was conducted, and a copy of this report has been furnished to the applicant, RUSTICO PUNZALAN, JR. (LPA) Dabuet will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions about the status of their application, they are instructed to contact the CAU Analyst assigned to their application.

END OF REPORT