Routine inspection·April 30, 2026

Licensing Program Analysts (LPAs) Arian Golbakhsh and Eryn Kane conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Vera Gajic, Administrator Nikola Subotic, and Staff Marko Kolomijcev. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, two (2) of which may be bedridden if on hospice only. Additionally, the facility is approved for a hospice waiver for six (6). During today’s inspection there were six (6) residents in care. Note, LPA Kane did have to leave at 3:30pm due to time constraints. LPAs and Administrator Subotic toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: common bathroom sink was 115.7F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients.  Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Subotic, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were in good operating condition. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed one (1) staff and one (1) client, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. Confidential records were stored in locked areas. While reviewing staff records, LPA noted that two (2) staff members (identified as S1 and S2) were not included on the facility's association roster. Upon review of the Guardian background check database, it was revealed that both had eligible background clearances, just that they were not associated to the facility. One Type A deficiency was issued for S1 and S2 not being associated to the facility. In addition, a Civil Penalty was assessed in the total amount of $1,000.00 and details are included on the attached LIC 421BG form. Licensee was able to associate S1 and S2 during the visit and LPA confirmed association. One deficiency was cited during the inspection. An exit interview was conducted with Administrator Subotic to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.