Facility Evaluation Report

On 03/07/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with Administrator Larisa Kononov and explained the purpose of the visit.

LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to the kitchen, dining room, residents bedrooms, bathrooms, common areas and backyard. LPA observed the facility to have sufficient food supplies for seven (7) day non-perishable and two (2) day perishable. LPA observed toxins, knives and centrally stored medications to be locked and inaccessible to residents in care. All required Licensing posters are present in common areas in the facility. Hot water temperature was measured at 117.2 degrees Fahrenheit at the bathroom sink, which is within the required range of 105 to 120 degrees. The temperature in the facility was 71 degrees. Fire extinguishers was last inspected on 12/06/23.

LPA conducted a file review of three (3) resident files and two (2) personnel files. LPA observed two (2) personnel files to be incomplete with no annual training.

LPA requested a copy of the current liability insurance to be sent to LPA Ratajczak by 03/21/24.

LPA completed the full care tool and deficiencies was observed. Please see LIC 809-D.

Exit interview conducted and a copy of the report and appeal rights was provided.