Routine inspection·January 27, 2022

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual Required visit and Infection Control Inspection of the facility. LPA arrived at 1:05 PM and was greeted by Celibi Salgado, Caregiver and explained the purpose of the visit. At the time of arrival, there were three (3) staff on duty and six (6) residents present. Ekaterina Zamyatina was present at the time of LPA’s arrival. Anton Zamyatin arrived at approximately 1:40 PM. Entrance interview conducted. There are currently six (6) residents residing in the facility. The facility is a one-story Residential Care Facility for the Elderly (RCFE). Currently, there are two residents 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. There are eight (8) dual carbon monoxide/smoke alarms are hard wired and will immediately notify the local fire department. The kitchen area was sufficiently stocked with two-day perishables and seven days of non-perishables. Snacks and beverages are readily available for Residents. Frozen foods are properly wrapped and stored appropriately. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. The kitchen has an oven, stove, refrigerator, microwave, bread maker, blender, steamer, and toaster. The residents’ eating utensils are specifically marked for each resident as a COVID-19 best safety practice. Medications, First Aid kit, and additional first aid supplies are kept in a locked centrally stored cabinet located in the dining area. Residents’ medication dishes are specifically marked for each resident as a COVID-19 best safety practice. Please continue to 809-C The recycling bin, green waste bin, and trash bins are standard bins with flip lids. There is a locked storage shed with gardening tools and equipment. The contents of the storage shed are inaccessible to residents in care. The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature at 69.8 degrees Fahrenheit (F). Hallways, bedroom doors, and walls are in good repair. There are six private bedrooms. Bedrooms #1, 4, 5, 6 and 7 have private-half bathrooms. Bedroom #3 has a bathroom across the hallway. Bedroom #2 is an employee room and remains locked at all times with no access by residents in care. Each bedroom has a bed, nightstand, and a lamp to provide sufficient lighting. There is one full-size bathroom/shower room utilized for all residents. The bathrooms have secure grab bars and no skid flooring. Residents’ files and personnel files are kept in a locked cabinet in the dining area. All persons associated with the facility have criminal record clearance. Exit interview conducted. No citations issued. A copy of this report has been issued.