Facility Evaluation Report

On 03/27/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with Staff Member (SM), Phornsack Thevathath and explained the purpose of the visit. LPA asked that SM Thevathath call the Facility Designated Administrator (FDA) to inform them that CCL was present at this time. Shortly after, LPA Pascua met with FDA Mai Xiong and explained the purpose of the visit.

Current census was 3. 1 out 3 residents were out at their respective day program at this time. There was also one resident present from a sister facility at this time. The residents were observed in the back patio and were working on a puzzle and playing basketball. Shortly after, the residents were served lunch during this visit.

This facility is licensed to serve up to 4 residents who deemed ambulatory only. This facility is also vendorized by Valley Regional Center to hold and accept Level 6 residents at this time. A brief interview with FDA Xiong was conducted.

LPA reviewed 3 resident files and 3 staff files. All files were observed to be current and up to date. The Facility Designated Administrator currently holds an active administrators certificate #6050083735 and expires on 10/29/2026.

A tour of the facility was conducted. Fire extinguisher located in the kitchen and was serviced on 1/9/2026.

LPA observed a locked centralized stored medication cabinet located in the hallway. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.