Facility Evaluation Report

Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility unannounced to conduct a required annual visit. LPA explained the purpose of the visit and was granted entry by Caregiver. Administrator (AD), Phoeun Marez was called and she promptly arrived.

The residence was set at 73 degrees F temperature and free of passageway obstructions inside and outside. LPA observed six bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Water temperature was checked and was at 114.7 F.

Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in the kitchen area. Cleaning supplies are locked and stored in the garage and under the kitchen sink. Smoke detectors and carbon monoxide were checked and operating. Fire extinguishers was serviced on 11/03/25. Last drill completed on 01/07/26. There was outdoor seating for the residents. Outdoor area was clean and free of obstruction.

LPA and AD discussed storage options for resident medication boxes, to make assisting in the administration easier for the staff.

During the visit a file review was conducted for three residents and three staff files.

An exit interview was conducted, and a copy of this report was provided to Administrator whose signature confirms receipt.

LPA requested the following updated forms faxed to CCLD by 02/06/2026: Personnel Report (LIC 500), Proof of current Liability Coverage.