Facility Evaluation Report

Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced Required Annual Visit on 09/12/25 using the CARE Inspection tool. LPA was met by Staff #2 Jerome Unica and Staff #3 Gener Gutierrez and explained the purpose of the visit. S2 assisted in the tour of the facility and Administrator Rathay Suy arrived later during the facility tour. The facility is licensed to serve clients of age 18 to 59 years old clients and has a fire clearance approved for six (6) non-ambulatory of which one (1) may be bedridden and approved hospice waiver for three (3) clients. There were one (1) resident under hospice care. .

A tour of the single-story facility began at approximately 9:10am that included residents’ rooms: one (1) private staff bedroom, four (4) bedrooms, two (2) bathrooms, living room, dining area, kitchen, backyard, garage/laundry room/storage space.

All residents’ bedrooms have the required furniture for privacy, comfort, and safety. Additional bedding supplies and grooming supplies were observed in the hallway cabinets securely locked. Bedrooms #4 had an exit door. Bathrooms were observed clean and in good repair. Each is in working condition, showers were observed with grab bars and skid mats aside the wall. Water temperature was tested in each bathroom sinks measuring 125.0 degrees F - 125.2 degrees F., which is not within the required 105-120 degrees F.

LPA observed the Infection Control Plan revised 06/26/25 and Emergency Disaster Plan revised 06/26/25. Last documented emergency drill conducted on 06/26/25. First Aid kit observed and (2) Fire Extinguishers were observed and last checked on 06/13/25. Carbon monoxide detector, smoke detectors, and auditory signal systems were in working order located throughout facility . LPA Madyun observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Madyun observed the emergency food supply in kitchen cabinet.