Routine inspection·July 26, 2023

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection visit to the above-named facility. LPA arrived at 10:50 am and was greeted by Staff 1 (S1). Valentyna Polunets, Co-Administrator arrived at approximately 11:15 am. Administrator Victoriia Andreichenko arrived at approximately 12:02 pm. At the time of arrival, there were 6 residents in care and 1 staff on duty. 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. 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. First aid kits were 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 4/21/2023. There is a total of one dual smoke/carbon monoxide alarm and six 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 locked centrally stored cabinet. Sharps are kept in a locked cabinet in the kitchen. The backyard has a covered patio with outdoor furniture, a gazebo, paved walkways, and a locked shed. The front yard is conducive for outdoor visitation. The front yard has paved walkways and garden areas. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The 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. The facility has six (6) bedrooms for a capacity of six residents. Bedroom #1 has a private bathroom. There Please continue to 809-C, Pg 2. are three bathrooms available for residents located off the hallways of the facility. All of the bedrooms are furnished with lights and nightstand lamps to provide sufficient lighting. There is one resident currently on hospice. All persons associated with the facility have a criminal background clearance. All trainings are up-to-date. Exit interview conducted. No deficiencies noted. Copy of report issued during the visit.