Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Vladmir Kravchenko and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents with a hospice waiver for 2. Facility is a single story home with 4 bedrooms, 3 bathrooms, staff room, living room, family room, dining room, kitchen and a 3 car garage. LPA observed the See Something, Say Something poster (PUB 475) posted in the living room of the facility. Vladmir Kravchenko's Administrator's Certificate expires on February 5, 2027. LPA and the Administrator toured the facility. The fireplace in the living room and the fireplace in the family room are both screened. LPA observed the kitchen is clean and organized. The fire extinguisher in the kitchen is fully charged. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the knives and sharp objects are kept locked and inaccessible to residents. Emergency food and water is stored in the kitchen pantry. LPA observed all resident rooms had the required furnishings. LPA observed all bathrooms are clean and operational. Hot water measured 118.5 degrees Fahrenheit in shared bathroom in the hallway by the garage door. The garage is kept locked and used for storage. LPA observed extra food and cleaning supplies stored in the garage. LPA and Administrator toured the backyard. LPA observed that there is an in-ground spa in the backyard. The spa is covered with a heavy wood cover that is safe to walk on. LPA observed the exit gate is operational. There is seating area with an umbrella for shade. No obstacles or hazards observed inside or outside of the facility. LPA observed all staff present at the facility are background cleared and associated to the facility. LPA observed both staff had a valid CPR/First aid card. LPA reviewed 2 resident files, no discrepancies observed. LPA inspected the first aid kit. The first aid kit has all the required elements. No deficiencies observed during the visit. LPA consulted with the Administrator regarding reporting requirements. An exit interview was conducted and a copy of the report provided.