Pre-licensing visit·December 19, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a pre-licensing inspection and was greeted by caregiver. Applicant, Dina Bruk was not available to come to the facility. LIC308 designee will sign report. Administrator certification: Dina Bruk Administrator Certificate 6071278740 expires 7/17/2026. At approximately 9:30am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. LPA observed, within regulation, emergency supply of non-perishable food. Hall closet containing cleaning supplies was locked. Kitchen drawer with sharp knives inaccessible to residents in care. Facility is a one story residence with six [6] bedrooms, five [5] full bathrooms, kitchen and dining and living room common areas. Shaded outside area available for recreation and visitation. All resident rooms are furnished per regulation with a bed, lamp, dresser, chair and bedside table. Rooms that have exit sliding doors have alarms present and functioning. Fire extinguishers were last inspected 7/29/24. Smoke/Carbon Monoxide detectors located throughout the facility are hardwired and last serviced by Stryker Fire and Security in October of 2024. Facility’s last quarterly disaster drills were conducted 10/03/2024. Facility has a backup generator for use during a power outage. Water temperatures read at: 136.8 degrees F in kitchen, 136.4 degrees F in main bath, 117.5 degrees F in room #6, and 135.8 degrees F in room #4, and 135.9 degrees F. Regulation requires water temperatures to be within 105 & 120 degrees F. LPA advised designee all but the 117.5 reading are outside regulation. Designee will work with applicant turn the water heater down and get the temperature down to within regulation. Continued on 809C... Continued from 809... Separate residence with private tenant located in the back of the facility. Residence does not share any walls with the facility. The tenant does not access the facility; however, they do use the stacked washer and dryer in the garage. Residents do not have access to the garage. The following item needs to be corrected prior to LPA submission of facility's application for approval: water temperature throughout the facility must be within regulation of 105 & 120 degrees F. Applicant to provide photos of temperature readings for the following: kitchen, hall main bath, and rooms #6, #4, and #2 that show water temperature within regulation. Once acceptable photographic proof is received by CCL, LPA will submit facility's application for approval. Comp III reviewed. Exit interview conducted with caregiver and copy of report given