Routine inspection·January 31, 2022

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual Required visit and Infection Control Inspection of the facility. LPA arrived at 1:55 pm and was greeted by Staff 1, Caregiver and explained the purpose of the visit. At the time of arrival, there were two (2) staff on duty and five (5) residents present. Staff 2 (S2) Caregiver was present. Timothy Pryko, Licensee, arrived at approximately 2:11 pm. Entrance interview conducted. There are currently five (5) residents residing in the facility. The facility is a one-story Residential Care Facility for the Elderly (RCFE) including residents with a Dementia diagnosis. There is currently one resident on hospice. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked. The facility was seen to be in good repair inside and outside. Fire inspection was current. The carbon monoxide alarm and smoke alarms are hard wired and in good working order. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. The fire extinguisher and First Aid kit are kept behind the side entrance door of the facility. First aid kit was observed to be complete. The front yard consists of slopped concrete walkways and garden areas. The backyard has a patio and walkways with a gazebo and outdoor furniture, two locked storage sheds with additional supplies, and two locked staff rooms. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Please continue to 809-C, Pg 2. The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable room temperature. Hallways, bedroom doors, and walls are in good repair. There are six private bedrooms with private bathrooms. Each bedroom has a bed, nightstand, overhead lights and/or nightstand lamps to provide sufficient lighting. The bathrooms have secure grab bars and no skid flooring. LPA advised Administrator that COVID-19 screenings should be done with all visitors, staff, and residents who return from outings upon entry into the facility. LPA advised Administrator that CDSS PINs and CDSS PIN summaries should be readily available to residents, staff, and visitors. LPA advised Administrator that visitation policies and COVID-19 awareness posters should be made available prior to entering the facility. Exit interview conducted. No deficiencies cited. Report issued via email.