Facility Evaluation Report

This report is a copy of the annual inspection report dated 06/20/25, due to technical difficulties.

On 06/20/25, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Manager Sokha Sea as the purpose of the visit was explained. The facility is licensed to serve (11) medically fragile adults ages 18 and over of which (4) may be non-ambulatory. Current census is (9). Facility annual info was provided (balance $499 PIN 286467).

The facility is a two-story residential home, with a two-story carriage house that has an attached (3) car garage. The front house consists of (11) resident bedrooms, (5) resident bathrooms, (1) staff bathroom, living room, kitchen, dining room, breakfast nook, and butler’s pantry. The two story carriage house serves as staff office(s), has a pantry room, and also has a laundry room with (2) washer and (2) dryer. The backyard was observed to have a table and chairs, and a wheelchair ramp. There is an additional refrigerator and freezer located in the garage as well as additional laundry and hygiene supplies. There are no weapons nor bodies of water on the premises. (5) Bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to residents.

LPA conducted a records review of 4 staff records, 5 client records, and 5 medication administration records, no discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 05/23/25, (9) fire extinguisher fully charged throughout the home, carbon monoxide and smoke detectors are interconnected and operational. A landline was observed.

Exit interview conducted, and a copy of this report was provided.