Routine inspection·July 20, 2022

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced on-site one-year Infection Control Inspection and Annual visit to the above-named facility. LPA arrived at 12:53 pm and was greeted by Staff 1. Administrator Viktoria Andreichenko arrived at approximately 1:13 pm. At the time of arrival, there were 5 residents in care and 1 staff on duty. A Mitigation Plan has been submitted to CCLD. LPA explained the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) and is home to non-ambulatory residents with a Dementia diagnosis and a Hospice Waiver for four residents. Currently, there are no residents on hospice. Entrance interview conducted: 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 facility maintains a comfortable room temperature. First aid kit was observed to be complete. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. There is one fire extinguisher on the premises last serviced on 6/23/2022. There is a total of one (1) carbon monoxide detector and seven (7) smoke alarms throughout the facility all in good working order. Snacks and beverages are available for residents in care upon request. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Cleaning agents and the toxic chemicals are kept in a locked garage. Medications are kept in a cabinet located in the Administrator’s office. Sharps are kept in a cabinet above the microwave oven located in the kitchen. LPA advised Administrator that although the cabinet is out of reach of most residents, a lock on the cabinet would add additional re-assurance that the sharps are inaccessible to residents in care. Administrator placed a lock on the cabinet during LPA's visit. Please continue to 809-C, Pg 2. The backyard has a deck with table and chairs, a gazebo, raised garden area and a ramp for access throughout the yard. The backyard is conducive for outdoor visitations. The front yard has garden areas and access as the main entrance into the facility. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The facility has three (3) shared bedrooms for a capacity of six residents. All of the bedrooms are furnished with lights and nightstand lamps to provide sufficient lighting. Bedroom #1 and 2 utilize a bathroom off the hallway. Bedroom #3 has a private bathroom utilized only by the residents who reside in Bedroom #3. All persons associated with the facility have a criminal background clearance. Exit interview conducted. No citations issued at this time. Copy of report issued via email.