Routine inspection·July 2, 2025

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection visit to the above-named facility. Upon arrival, LPA was greeted by Staff 1 (S1) and explained the purpose of the visit. Administrator Valentyna Polunets arrived at approximately 12:22 pm. Administrator Viktoriia Andreichenko arrived at approximately 12:40 pm. At the time of arrival, there were 6 residents in care and 1 staff on duty. The facility is licensed as a Residential Care Facility for the Elderly (RCFE) with a dementia diagnosis, has a fire clearance for 6 non-ambulatory residents (of which one may be bedridden) and a hospice waiver for 3 residents. Currently there is currently 1 resident 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 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, doors, floors and floor coverings were checked. There is one fire extinguisher on the premises last serviced on 6/2/2025. Snacks and beverages are available between meals for residents in care. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Cleaning agents and the toxic chemicals are kept in a locked garage. Sharps are kept in a locked cabinet in the kitchen. Please continue to 809-C, Pg 2. 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 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. Residents participate at will in activities such as music entertainment, dance movement, range of motion exercise, socialization, puzzles, journals, reading materials, and outings with family and personal companions. Residents’ records are complete with Admission Records, Needs and Services Plan, Health Screenings, and Physician’s Reports. Staff records are complete with Personnel Records, Trainings, Health Screenings, and current First Aid/CPR training. All Staff have a fingerprint clearance and have been properly associated to the facility. Exit interview conducted. No deficiencies noted. Copy of report issued at the time of the visit.