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Inspection visit

Incident investigation

PINE HOLLOW CARE HOMELicense 3470043071 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

LPA Williams arrived on Friday, October 8, 2021 to open a separate complaint investigation. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured he applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA was screened at front door. LPA met with Tatyana Matskevich, Administrator, and requested an Appraisal/Needs and Services Plan, amongst other things. The facility does not have an Appraisal/Needs and Services Plan.

Citations

1 citation recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 874579(c)(1)Type B

    87457(c)Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs (1)The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors. Facility has not filled out a Needs and Services plan (LIC625) for resident which poses an immediate health and safety concern for the resident

FAQ · About this visit

Common questions about this visit

What happened during the October 8, 2021 inspection of PINE HOLLOW CARE HOME?

This was a other inspection of PINE HOLLOW CARE HOME on October 8, 2021. 1 citation were issued: 1 Type B.

Were any citations issued to PINE HOLLOW CARE HOME on October 8, 2021?

Yes, 1 citation was issued (0 Type A, 1 Type B). The first citation was for: "87457(c)Prior to admission a determination of the prospective resident's suitability for admission shall be completed an..."

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.