Facility Evaluation Report

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced required visit to the facility for the purpose of conducting the required annual inspection. LPA Rodriguez explained reason for visit and was greeted and granted entry by Facility Administrator (AD) Joanna Manczyk. For this visit, there are a total of five staff members on duty, of which are background cleared and associated to the facility.

The PUB475 "See Something, Say Something" poster was observed to be located in the hallway. LPA observed the Administrator's Certificate for Joanna Manczyk which expires on 4/22/2026 and Barbara Manczyk which expires on 11/7/2025.

LPA toured the interior and exterior portions of the facility with AD Manczyk. The facility is a two-level structure and is licensed for 6 residents, of which 0 may be bedridden and 4 may be on hospice . For this visit, there are a total of 4 residents in care, of which 1 is on hospice and 0 are bedridden.

On the first floor, there are a total of 4 resident rooms, of which 1 is a shared resident room, 3 private resident rooms, and 5 bathrooms. On the second floor, there are a total of 2 bedrooms designated for staff use only, and 1 bathroom, which is also only designated for staff. LPA toured the second level and observed no residents or resident belongings residing on the second floor. LPA toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 107.8 degrees Fahrenheit.