Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jan 3, 2025
Visit Reason
An unannounced annual facility evaluation visit was conducted to assess compliance with Title 22 regulations and ensure the facility meets health and safety standards.
Findings
The facility was found to be in compliance with regulations, with no health or safety hazards observed. All areas including food service, resident rooms, common areas, and emergency supplies were maintained in good condition and appropriate for resident use.
Report Facts
Approved fire clearance capacity: 6
Hospice waiver capacity: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Brian Phillips | Licensing Program Analyst | Conducted the inspection and authored the report |
| Timothy Pryko | Licensee | Facility representative met during inspection |
| Valerija Bohonko | Assistant Administrator | Facility representative met during inspection |
| Daniel Bond | Administrator/Director | Facility administrator named in report |
| Kelly Burley | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jan 25, 2024
Visit Reason
The visit was an unannounced required Annual Facility site inspection to ensure compliance with Title 22 Regulations for a Residential Care Facility for the Elderly (RCFE).
Findings
The facility was found to be in compliance with all applicable regulations, with no health or safety hazards observed. The physical plant, kitchen, common areas, bedrooms, restrooms, medication storage, infection control, and facility documentation were all inspected and found to be in good condition with no deficiencies cited.
Report Facts
Capacity: 6
Census: 6
Food supply duration: 7
Number of resident bedrooms: 6
Number of resident restrooms: 6
Number of co-administrators: 3
Number of fire extinguishers: Multiple fire extinguishers fully charged and serviced in 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Timothy Pryko | Co-Administrator/Licensee | Met with Licensing Program Analyst during inspection |
| Valerija Bohonko | Co-Administrator | Met with Licensing Program Analyst during inspection |
| Daniel Bond | Administrator | Facility Administrator named in report header |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 2
Dec 21, 2022
Visit Reason
An unannounced one-year Infection Control Inspection visit was conducted as part of the required annual inspection for the Residential Care Facility for the Elderly.
Findings
The facility was generally found to be in good repair and clean, with adequate supplies and infection control measures in place. However, deficiencies were cited for staff not wearing face coverings correctly and unlocked medication storage posing immediate health and safety risks.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Staff 1 and Staff 2 were not wearing face coverings correctly, posing an immediate health, safety, and personal rights risk to residents. | Type A |
| Medication cabinet located to the right of the stove was unlocked and medications in a refrigerator in the food pantry were not locked, posing an immediate health and safety risk to residents. | Type A |
Report Facts
Residents in care: 6
Licensed capacity: 6
PPE supply: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Timothy Pryko | Administrator | Administrator present during inspection |
| Daniel Bond | Co-Administrator | Co-Administrator participating in inspection |
| Lidia Kravchuk | Co-Administrator | Co-Administrator participating in inspection |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Jan 31, 2022
Visit Reason
An unannounced Annual Required visit and Infection Control Inspection of the facility was conducted to assess compliance with licensing requirements.
Findings
The facility was found to be in good repair, clean, and well maintained with no deficiencies cited. Fire safety equipment and infection control measures were observed to be in place and functional.
Report Facts
Residents present: 5
Licensed capacity: 6
Staff on duty: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Timothy Pryko | Administrator | Facility Administrator present during the inspection |
| Kristin Kontilis | Licensing Program Analyst | Conducted the inspection |
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