Inspection Report Summary
Most inspections found no deficiencies, showing the facility generally maintained a clean and safe environment with proper safety equipment and documentation. Some isolated issues arose, including an expired administrator’s certification in March 2022 and incomplete medical assessments missing tuberculosis test results in April 2025. A complaint investigation in February 2024 substantiated that the licensee improperly held financial Power of Attorney for a resident, which is against regulations and poses a risk to resident rights. Several other complaint investigations, including one alleging financial abuse, were unsubstantiated. The most recent report from April 23, 2025, had a minor deficiency but otherwise showed compliance, indicating stable performance with occasional isolated concerns.
Deficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 1
Apr 23, 2025
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and ensure the safety and well-being of residents.
Findings
The inspection found the facility generally compliant with safety and environmental standards, including proper food storage, fire safety equipment, and accessible pathways. However, a deficiency was noted regarding incomplete medical assessments for one resident who lacked tuberculosis test results and chest x-ray documentation.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| A resident did not receive tuberculosis test results during their medical assessment, nor did they receive results of a chest x-ray, posing a potential health, safety, and/or personal rights risk. | Type B |
Report Facts
Residents present: 5
Total capacity: 6
Staff files reviewed: 4
Resident files reviewed: 4
Fire extinguisher inspection date: Mar 24, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Renee Campbell | Licensing Program Analyst | Conducted the inspection and authored the report |
| Lidia Hiriscau | Administrator | Facility administrator met during inspection and exit interview |
| Beniamin Siriciurdas | Caregiver | Met during inspection |
| Lisa Rios | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Mar 25, 2024
Visit Reason
The inspection was an unannounced required 1 year annual visit to evaluate the facility's compliance with regulatory standards.
Findings
The facility was found to be well maintained, sanitary, and in substantial compliance with no deficiencies issued. Some resident files contained outdated physician reports and missing pages in Needs and Service Plans, for which technical assistance was provided.
Report Facts
Resident files reviewed: 5
Resident files with outdated physician reports: 3
Resident files missing pages 2 and 3 of Needs and Service Plans: 5
Needs and Service Plans older than one year: 3
Caregiver files reviewed: 3
Residents interviewed: 4
Staff members interviewed: 2
Fire extinguisher last serviced: 2024
Water temperature: 107
Facility thermostat temperature: 73
Facility capacity: 6
Current census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lidia Hiriscau | Licensee / Administrator | Met with Licensing Program Analyst during inspection |
| Maja Jensen | Licensing Program Analyst | Conducted the inspection and provided technical assistance |
| Lisa Rios | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 1
Feb 28, 2024
Visit Reason
The inspection was conducted as a complaint investigation related to complaint control number 27-AS-20230921092607, focusing on the licensee's designation as the financial Power of Attorney for a resident.
Findings
The investigation confirmed that the licensee was designated as the financial Power of Attorney for Resident 1, which is a violation of regulations prohibiting licensees from accepting any general or special power of attorney for residents. This poses an immediate risk to the health, safety, and personal rights of residents in care.
Complaint Details
The complaint investigation was related to complaint control number 27-AS-20230921092607. The licensee was substantiated as having taken over as Resident 1's financial Power of Attorney, confirmed by interviews and a notarized document dated 09/23/2023.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Safeguards for Resident Cash, Personal Property, and Valuables...no licensee or employee of a facility shall accept any general or special power of attorney for any such person. This requirement was not met as evidenced by the licensee being appointed as Resident 1's Power of Attorney. | Type A |
Report Facts
Capacity: 6
Census: 6
Deficiency count: 1
Plan of Correction Due Date: Feb 29, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lidia Hiriscau | Licensee/Administrator | Named in relation to the finding of accepting Power of Attorney for a resident |
| Lisa Rios | Licensing Program Manager | Present during meeting delivering findings and supervisor for the inspection |
| Maja Jensen | Licensing Program Analyst | Conducted the inspection and licensing evaluator |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 0
Feb 28, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation received on 09/21/2023 that facility staff was financially abusing a resident.
Findings
The investigation included interviews with the licensee, residents, responsible parties, and review of financial and facility records. The allegation of financial abuse was found to be unsubstantiated based on the preponderance of evidence.
Complaint Details
The complaint alleged financial abuse of a resident by facility staff. After investigation, including interviews and document review, the allegation was determined to be unsubstantiated. A separate case management is ongoing to address safeguards for cash, personal property, and valuables.
Report Facts
Facility capacity: 6
Resident census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lidia Hiriscau | Licensee | Named in investigation and interviews regarding financial abuse allegation |
| Lisa Rios | Licensing Program Manager | Oversaw complaint investigation and signed report |
| Maja Jensen | Licensing Program Analyst | Conducted investigation and signed report |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Apr 5, 2023
Visit Reason
Unannounced annual visit conducted to evaluate the facility's compliance with health and safety regulations.
Findings
The inspection found the facility to be in compliance with no deficiencies cited. The environment, medication storage, resident rooms, safety equipment, and documentation were all inspected and found satisfactory.
Report Facts
Non-perishable food supply: 7
Perishable food supply: 2
Residents non-ambulatory: 3
Residents on hospice: 2
Resident bedrooms: 4
Fire extinguisher last inspection date: Jan 30, 2023
Resident files reviewed: 5
Staff member files reviewed: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lidia Hiriscau | Facility Administrator | Met with Licensing Program Analysts during inspection |
| Kimberly Viarella | Licensing Program Analyst | Conducted the inspection and signed the report |
| Charlie Yang | Licensing Program Analyst | Conducted the inspection |
| Liza King | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 1
Mar 28, 2022
Visit Reason
An unannounced annual inspection was conducted to evaluate the facility's compliance with regulations and licensing requirements.
Findings
The facility was found to have clean and well-maintained living spaces, adequate food supply, operational safety equipment, and proper staff background clearance. However, a deficiency was cited due to the administrator's certification being expired, posing a health, safety, or personal rights risk to residents.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Administrator's certificate expired 03/16/2022 which poses a health, safety or personal rights risk to residents in care. | Type B |
Report Facts
Capacity: 6
Census: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lidia Hiriscau | Licensee and Administrator | Named in relation to expired administrator certification deficiency |
| Sarah Hurt | Licensing Program Analyst | Conducted the inspection and signed the report |
| Stephenie Doub | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 0
Dec 3, 2021
Visit Reason
The inspection was an unannounced annual inspection conducted to evaluate the facility's compliance with regulations.
Findings
The facility was found to be in good condition with no deficiencies observed or cited. All safety equipment and protocols, including fire extinguishers, smoke alarms, carbon monoxide detectors, and disaster drills, were compliant with regulations.
Report Facts
Continual Administrator's Certification expiration: Mar 16, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lidia Hiriscau | Administrator | Met with Licensing Program Analyst during inspection |
| Sarah Hurt | Licensing Program Analyst | Conducted the inspection |
| Stephenie Doub | Licensing Program Manager | Named in report header |
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