Pre-licensing visit·April 5, 2021

On 4/5/21, Licensing Program Analyst (LPA) Kevin Mknelly conducted a tele-visit via Facetime with Licensee, Estera Maciuca, at approximately 1:00 PM. LPA was unable to meet at the facility due to current circumstances. LPA toured Physical Plant, Food Service, Common Areas, Bedrooms, Bathrooms, Kitchen and Medication Storage. Fire extinguisher is current and First Aid is fully stocked. Kitchen was clean and good repair. Licensee has knowledge of (7) seven (2) two day supply of non-perishable and perishable, and required emergency shelter in place supplies. Model rooms inspected have appropriate items and are in good repair. Water temperatures requirements were reviewed Licensee will send measured temperatures to LPA. LPA observed centrally stored medications and toxins are to be kept locked and inaccessible to residents. Staff and resident files are to be set up to contain required documents. Covid 19 guidelines and signage discussed and signs are present for posting. Licensee will submit an updated facility sketch. Facility will accept total capacity of six elderly residents. LPA observed this facility appears to be clean, safe, and secured. All common areas appear to be free from hazards, clean and in good repair. As of this date, the Department has received the fire clearance. During this visit, this facility is in substantial compliance and meets the minimum requirements for a RCFE license. Component III was waived. Application is pending further review. Unable to obtain signature. Signature present on hard copy in file. LPA sent a copy of report for Administrator to sign. Administrator to send a signed copy back to CCL.