Facility Evaluation Report

Unannounced Annual visit made out to this facility on 05/11/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility caregiver, Carrie Phommarath, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator to inform them that CCL was present at this time. The facility designated representative, Sophia Patterson, arrived shortly thereafter to this facility and was briefly interviewed at this time.

Current census was 3 residents. It was learned that there was (1) resident under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (4) residents under the care of hospice at any given time.

It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there were (2) residents receiving services through home health at this time. It was learned that this facility does have an approved bedridden fire clearance to be able to accept or retain any residents deemed to be bedridden at any given time. There weren't any residents deemed to bedridden at this time.

Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.

Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time.

Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed.

Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times.