Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Tetyana Hankevych, Administrator, and stated the reason for today's inspection. Also present was Andrii Chornei, caregiver. LPA observed (1) resident in the common area, (1) in their room, and (3) were out of the facility. (1) resident returned during the inspection. Currently (1) resident is under hospice care.

LPA and the Administrator toured the interior/exterior of the facility including the common areas, (6) resident bedrooms, (4) half-bathrooms and (1) main bathroom, kitchen, staff room, garage and locked laundry area. The upstairs area is not used by residents and has a locked gate for staff access only. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars and skid-resistant flooring.. Hot water measured 120*F in the kitchen and a resident bathroom. LPA observed sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps are locked in the kitchen, medications are secured nearby, and toxins are secured in the laundry room. Inside temperature was 72*F. Smoke/monoxide alarms are functioning. Fire extinguisher was last serviced 6/24/2025. There is a covered patio with seating and (1) unlocked gate. All exit doors have alarms.

LPA reviewed (2) resident files and (7) staff files. Files were organized and contained current paperwork, including required staff training. Medications were reviewed for (1) resident and no discrepancies were noted. All staff is cleared/associated. Administrator has current RCFE Administrator Certificate #7010593740 (exp 8/7/27). LPA obtained a copy of the current liability insurance and LIC500 and requested an updated LIC308. Staff are aware of where the utility shut off valves are. There were no blockages near doorways. Medication Resource Guide was provided and a copy of Reg 87463. There were no deficiencies observed and no citations issued in this report. Exit interview with Administrator. Copy of report provided.