Routine inspection·January 26, 2026

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff and explained the reason for the visit. Administrator, Ruslan Levin was contacted and arrived shortly after. At approximately 9:40 AM, with the assistance of the staff, LPA took a tour of the physical plant. LPA observed the following: Kitchen : Required postings were observed in the kitchen. The fire extinguisher is located in the kitchen with purchase date 01/26/26. The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Medication Room : Medication room was observed to be locked. Smoke detectors/carbon monoxide : Dual smoke and carbon monoxide detectors were located throughout the facility and were tested and observed to be operational. Bedrooms: There were six (6) bedrooms designated for residents' use. All bedrooms are designated for private use. All six (6) bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting . Bathrooms: There are five (5) bathrooms designated for residents' use. All bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathrooms sink at 106.3, 109.2, 112.3 and 115.6 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas : These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit . Surrounding Grounds : Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. (Continue on 809 C) Resident Files : LPA conducted a file review of resident records to ensure compliance with licensing forms. LPA observed that R1's, R2 and R3's file have no updated physician report (LIC 602). In addition, R1's,R2's, and R3's lacks appraisal needs and services (LIC 603A). LPA was informed that Resident #5 (R5) passed away on 08/16/25, and the Administrator did not submit a Death Report to Community Care Licensing (CCL). The Administrator also failed to submit a Death Report for Resident #6 (R6), who passed away on 01/13/26. Staff Files : LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Medications : Medication and Medication Records were review for proper documentation. LPA observed that R1's through R4's medication records were inconsistent Temperature: Facility maintains a comfortable temperature of 78 degrees Fahrenheit An exit interview was conducted. Citations and civil penalties for repeated violations were issued. A referral to the Technical Support Program (TSP) was made with the Administrator’s agreement. A copy of this report was signed and provided to the Administrator. Appeal Rights were provided.