Facility Evaluation Report

At approximately 12:25PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year Visit and met with Administrator, Paul Durancyzk . Facility is a Continuing Care Retirement Community (CCRC) and has a portion of the property licensed as a Residential Care Facility for the Elderly (RCFE). This portion of the property provides care and assistance for Older Adults in Assisted Living. Facility has an approved fire clearance and capacity for 28 Non-Ambulatory or Bedridden Residents. Facility has a Hospice Waiver for 5 individuals. Upon arrival, LPA was informed that there were currently 13 residents in care and 3 staff members on-site.

At approximately 12:50PM, LPA reviewed the Facility's Staff Roster and found that all staff members on site were background cleared and associated to the facility per regulation. LPA reviewed staff files. Staff files were all found to be well organized, thorough and contained the required documentation. Files were all found to have current First Aid and CPR certification. Administrator's Certificate for Paul Durancyzk was current with an expiration date of 10/26/2025.

Facility's fire extinguishers and facility hardwired smoke/carbon detectors were last inspected June 2025. Facility's sprinkler system were last inspected May 2025. Facility's last emergency/disaster drill was conducted June 2025.

LPA unable to complete the Annual Inspection. Annual Continuation Visit to be conducted at a later date to complete review of staff training, resident files, and resident medication.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.