Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection and met with Tetyana Hankevych, Administrator, and stated the reason for today's inspection.

Also present was caregiver, Andrii Chornei, caregiver. LPA observed all residents to be in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently there are (0) residents on hospice. LPA observed a social worker departing at the start of the inspection.

LPA and the administrator discussed the pending eviction for resident (R1). The department approved the 30-day eviction notice to be lawful on October 23, 2025 due to not following House Rules. LPA was advised that new placement is still pending, and the administrator will continue to work with (R1's) health care program and advise the Department accordingly.

LPA toured the facility and observed everything to be clean, safe and in good repair. LPA observed all but (1) resident in their rooms at the time of the tour. LPA and the administrator observed (R1) to be in their room watching television after taking a shower. (R2) was in the common area at the end of the inspection.

The administrator will provide any updates to the department on (R1's) new placement. There are no deficiencies issued in this report.