Facility Evaluation Report

At 11:00am on 08/11/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to conduct the facility annual inspection. LPA met with Designated Administrator, Lida Kravchuk, announced who he is and the reason for the visit.

This facility has 6 bedroom, 7 bathroom, living room, dining room, kitchen, laundry room, with a fenced f yard and a in back yard with seating under a covered patio, that can be used for resident activities, visiting and lounging. There are six single occupancy resident rooms, all with on suite bathrooms. Each room has proper furniture, storage, and linin to meet regulation requirements. The seventh bedroom is a staff bedroom/office. LPA observed hard wired smoke detectors through out the facility that are hardwired and functioning properly, three are dual carbon monoxide and three are smoke detector only. There is also additional carbon monoxide detector in the hallway. LPA observed a working fire extinguisher that was primed in the green reading in the living room. LPA observed a first aide kit in the same location as the fire extinguisher in the kitchen. LPA observed the medication cabinet in the kitchen to be locked and secured, LPA noted that the facility has at least two days of perishable foods and at least seven days of non perishable foods on hand for six residents and staff. LPA reviewed Emergency Disaster Plan, Infection Control Plan, Liability Insurance, and documented emergency disaster drill logs. LPA reviewed a sample of staff files and resident files. LPA conducted a cursory audit of Central Stored Medication Records (CSMR). LPA reviewed staff training and Facility Plan of Operations. LPA noted that there were no violations or citations as part of the facility physical inspection.

Designated Administrator and LPA conducted a full review of the annual care tools and noted no violations or citations. LPA noted no violations or citations as a result of this annual facility inspection.

Exit interview, report read, and report provided.