Highlands Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff and explained the reason for the visit. Administrator, Ruslan Levin was contacted and arrived shortly after. At approximately 9:40 AM, with the assistance of the staff, LPA took a tour of the physical plant. LPA observed the following: Kitchen: Required postings were observed in the kitchen. The fire extinguisher is located in the kitchen with purchase date 01/26/26. The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Medication Room: Medication room was observed to be locked. Smoke detectors/carbon monoxide: Dual smoke and carbon monoxide detectors were located throughout the facility and were tested and observed to be operational. Bedrooms: There were six (6) bedrooms designated for residents' use. All bedrooms are designated for private use. All six (6) bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are five (5) bathrooms designated for residents' use. All bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathrooms sink at 106.3, 109.2, 112.3 and 115.6 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. (Continue on 809 C) Resident Files: LPA conducted a file review of resident records to ensure compliance with licensing forms. LPA observed that R1's, R2 and R3's file have no updated physician report (LIC 602). In addition, R1's,R2's, and R3's lacks appraisal needs and services (LIC 603A). LPA was informed that Resident #5 (R5) passed away on 08/16/25, and the Administrator did not submit a Death Report to Community Care Licensing (CCL). The Administrator also failed to submit a Death Report for Resident #6 (R6), who passed away on 01/13/26. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records were review for proper documentation. LPA observed that R1's through R4's medication records were inconsistent Temperature: Facility maintains a comfortable temperature of 78 degrees Fahrenheit An exit interview was conducted. Citations and civil penalties for repeated violations were issued. A referral to the Technical Support Program (TSP) was made with the Administrator’s agreement. A copy of this report was signed and provided to the Administrator. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Jan 26, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced continuation of the annual visit. The LPA met with Administrator Ruslan Levin and explained the reason for the visit. During today's visit, the LPA reviewed files for three (3) residents to ensure compliance with licensing forms. LPA observed that R3 has an incomplete Admission Agreement and lacks appraisal needs and services (LIC 603A). Additionally, R4 and R5 have no updated physician report (LIC 602). LPA also conducted a review of staff records to ensure that forms and training are current and comply with licensing requirements. LPA noted that S2 and S3 are missing the LIC 503 forms. The administrator advised that all required forms will be emailed to LPA Agban promptly. Finally, LPA conducted a review of medication records. The LPA found that medications and medication records were inconsistent. Exit interview conducted, citations issued, appeal rights given and copy of this report delivered.the state’s words, verbatim · CDSS document, Apr 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff #1 (S1) and explained the reason for the visit. Administrator, Ruslan Levin arrived shortly after. At approximately 1:30 PM, with the assistance of the Administrator, LPA took a tour of the physical plant. Kitchen: Required postings were observed in the kitchen. The fire extinguisher is located in the kitchen with purchase date 12/12/24. The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Medication Room: Medication room was observed to be locked. Smoke detectors/carbon monoxide: Dual smoke and carbon monoxide detectors were located throughout the facility and were tested and observed to be operational. Bedrooms: There were six (6) bedrooms designated for residents' use. All bedrooms are designated for private use. All six (6) bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are five (5) bathrooms designated for residents' use. All bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathrooms sink at 113.8 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The garage: Laundry area is located in an attached garage and kept locked and inaccessible to residents. Resident Files: LPA conducted a file review to 2 out 5 residents to ensure compliance of licensing forms. Due to time constraints, LPA was unable to complete the annual inspection during today's visit. Administrator was informed that a follow up visit will be conducted. During today's the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff and explained the reason for the visit. Administrator, Ruslan Levin arrived shortly after. At approximately 10:45 am, with the assistance of staff, LPA took a tour of the physical plant. Kitchen: Required postings were observed in the kitchen. The fire extinguisher is located in the kitchen with purchase date 4/22/24. The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in the hallway cabinet. Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility and were tested and observed to be operational. Bedrooms: There were six (6) bedrooms designated for residents' use. All bedrooms are designated for private use. All six (6) bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are five (5) bathrooms designated for residents' use. All bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathrooms sink at 111.7, 115.0, and 116.3 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The garage: Laundry area is located in an attached garage and kept locked and inaccessible to residents. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records were review for proper documentation.LPA could not complete an accurate medication count due to incomplete medication forms. Exit interview conducted, citation issued and copy of this report delivered.the state’s words, verbatim · CDSS document, Apr 22, 2024