Facility Evaluation Report

On 12/02/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA was greeted by Staff Member (SM), Rita Southammavong and explained the purpose of the visit. LPA asked SM Southammavong to call the Facility Designated Administrator (FDA), Theresa Pettapiece that CCL was present. Shortly after, FDA Pettapiece arrived and met with LPA Pascua.

Current census was 63. A brief interview with FDA Pettapiece was conducted.

This facility is a full memory care facility licensed to hold and retain 72 non-ambulatory residents with a hospice waiver for 18. In addition, the facility has been approved for delay egress throughout the facility perimeter.

LPA Pascua reviewed 5 resident files and 5 staff files. All files were complete and in compliance at this time. The FDA has a current and active administrator certificate #7025930740 and expires on 07/07/2027. There are currently 14 residents on hospice and 1 resident receiving home health services.

This facility has a total of 60 bedrooms in which all are cleared for non-ambulatory residents. In addition, any bedroom can be used for a bedridden room.

All rooms designated as activity areas and common areas for resident use were toured. Furniture and furnishings were observed to be present and sufficient to meet the needs of the residents at this time.

Office rooms and other areas intended for resident use were toured.

Kitchen area was toured. Facility freezer and refrigerator units were toured. LPA reviewed the food storage supply to make sure that there was always a 2-day perishable and 7-day nonperishable food quantities on site at all times. Knives were observed to be locked and made inaccessible to the residents at this time. It was observed in that the facility has cafe areas equipped with a microwave and addition refrigerator present to cool, heat, and warm up food of the residents if necessary.

Storage area for chemicals and cleaning supplies were observed to be locked and made inaccessible to the residents at this time.