Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual, met with Oksana Doldier, Administrator, and explained the purpose of the inspection. Also present was Michael Doldier, staff. LPA observed (5) residents to be resting in their rooms during the inspection. The facility is licensed for (6) residents, all of whom may be non-ambulatory. There is an approved hospice waiver for (4) residents. Currently there are (0) residents on hospice. Inside temperature measured 71*F.

LPA and Administrator toured the interior/exterior of the facility including the common areas, (6) resident bedrooms, each with a full bathroom and sliding glass door, activity/movie room, kitchen, laundry area/garage. There are (2) resident rooms in the front section of the house and (4) resident rooms in the back section of the house. The bathrooms have the necessary grab bars, skid-resistant flooring, and hygiene supplies. There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Hot water measured 115*F in the kitchen. Sharps, medications and toxins are secured in the kitchen, with additional toxins locked in the laundry area. All exit doors have auditory alerts. Fire extinguisher was last serviced 10/27/2025. The smoke/monoxide alarms work. There is a walking path outside with trees, decorative birds and seating. There are no pools. There is (1) unlocked gate from the inside back patio. Required postings, including House Rules, are visible in the common area. There are (2) First Aid kits.

LPA reviewed (3) resident files and (2) staff files. Files were organized and contained current documentation. The Plan of Ops contains updates to the Dementia Care Plan (effec 1/25). LPA reviewed medications for (1) resident- orders matched medications being administered. Administrator and staff have completed current training. Administrator certification #7002171740- exp 12/12/2027. LPA obtained an updated copy of the current liability insurance and LIC308. There were no deficiencies observed and no citations issued in this report. Exit interview. Copy of report provided.