Facility Evaluation Report

Licensing Program Analysts (LPAs) Arian Golbakhsh and Eryn Kane conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Vera Gajic, Administrator Nikola Subotic, and Staff Marko Kolomijcev. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, two (2) of which may be bedridden if on hospice only. Additionally, the facility is approved for a hospice waiver for six (6). During today’s inspection there were six (6) residents in care. Note, LPA Kane did have to leave at 3:30pm due to time constraints.

LPAs and Administrator Subotic toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: common bathroom sink was 115.7F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment.

The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present.