Anita's Cottage

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an annual inspection, LPA was greeted by caregiver Nazrul Sekh, who allowed LPA to enter. There was (1) additional staff on duty. Administrator Mario Gurule was not available during the visit. The current census is (4). Facility license/sketch, grievance/complaint procedures, personal rights, Infection/Mitigation plan, Administrator certificate, emergency and complaint procedures was visibly posted. A physical plant tour of the facility inside and outside was conducted with caregiver Nazrul. The following common areas: living, dining, kitchen, resident bedrooms, and bathrooms were inspected: Kitchen: LPA observed a Licensing requirement of (7) day nonperishable, and (2) perishable, with extra refrigerator and freezer stocked with food in the garage. Food was properly wrapped, and appliances were functional, clean, and in good repair. Chemicals, household supplies, and knives, that are stored in the kitchen and garage area were locked and secured. Living/dining: All indoor passageways were free from obstruction; inside temperature was comfortable, with adequate lighting, and all areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (5) bedrooms; with (1) room for staff. All bedrooms were properly furnished and supplied with appropriate bedding and linens. There were sufficient linens observed and available; as well as personal hygiene products available for residents as well. Bathrooms: There are (2); all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured at 119.5 degrees Fahrenheit. Surrounding Grounds: There were no visible hazards; passageways were free from obstruction and gates were easily accessible to open. All exit doors have alarms; all were operating. Fire extinguisher was checked. First aid kit furnished fully equipped. Smoke alarms and carbon monoxide detectors are operating properly. Record review: A complete record review of staff and residents were conducted. All required documents in files. Exit interview and copy of report provided to caregiver.the state’s words, verbatim · CDSS document, Apr 7, 2026

Allegation investigated: . Staff are not following resident's Admissions Agreement 2. Staff did not give proper notice of resident's room change 3. Staff did not communicate with resident's responsible party

On 10/06/2025, Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility at 9:45 a.m. to conduct a subsequent visit, deliver the final findings regarding the above-mentioned complaint, and conduct a physical plant inspection. LPA met with caregiver Nazrul Sekh and explained the purpose of the visit. Administrator Mario Gurule was not available for the visit, but was notified. The following was determined: Allegation #1: Staff are not following residents’ Admission Agreement. To investigate this allegation, on 03/18/2025, from 11:00 a.m. to 12:30 p.m., (LPA) interviewed the complainant and obtained documents related to the complaint. On 03/20/2025, LPA conducted the initial complaint visit from 9:30 a.m. to 2:15 p.m., during which (2) staff and (2) residents, including Resident #1 (R1), were interviewed, and R1’s records were reviewed. A subsequent visit was conducted on 08/07/2025, from 11:20 a.m. to 12:30 p.m., to conduct additional interviews. According to R1’s Admission Agreement, R1 rented a private room with no roommate. Recently, the Administrator temporarily relocated R1 to a shared room to allow for repairs and renovations to the private room. (Cont'd LIC9099C) Unsubstantiated After the repairs were completed, R1 informed the LPA that the shared room was more comfortable and spacious and expressed a desire to remain there. R1 acknowledged being fully aware that the room is designated for shared occupancy and agreed to the possibility of having a roommate. R1 stated being happy, content, and wishing to stay in the shared space. Although it was reported that the facility was not following the Admission Agreement, evidence shows that R1 voluntarily chose to remain in the shared room, exercising their personal rights. Therefore, based on interviews and record reviews, there is insufficient evidence to prove or disprove the allegation. The allegation is deemed Unsubstantiated. Allegation #2: Staff did not give proper notice of residents’ room change. To investigate this allegation, on 03/18/2025, from 11:00 a.m. to 12:30 p.m., (LPA) interviewed the complainant and obtained documents related to the complaint. On 03/20/2025, LPA conducted the initial complaint visit from 9:30 a.m. to 2:15 p.m., during which (2) staff and (2) residents, including Resident #1 (R1), were interviewed, and R1’s records were reviewed. A subsequent visit was conducted on 08/07/2025, from 11:20 a.m. to 12:30 p.m., to conduct additional interviews. Information obtained during the investigation revealed that R1 was temporarily relocated to a shared room while renovations and repairs were completed in R1’s private room. Although it was noted that R1 has the power of attorney (POA) for financial and health decisions, R1 personally chose to remain in the shared room after the repairs were completed, exercising R1’s personal rights. Because this relocation was based on R1’s voluntary decision, and not an involuntary move imposed by facility staff, there was no requirement to issue formal notice of the room change. R1 confirmed to LPA that remaining in the shared room was R1’s personal choice and decision. Therefore, based on interviews, there is insufficient evidence to support the allegation. The allegation is deemed Unsubstantiated. Allegation #3: Staff did not communicate with resident's responsible party. To investigate this allegation, on 03/18/2025, from 11:00 a.m. to 12:30 p.m., (LPA) interviewed the complainant and obtained documents related to the complaint. On 03/20/2025, LPA conducted the initial complaint visit from 9:30 a.m. to 2:15 p.m., during which (2) staff and (2) residents, including Resident #1 (R1), were interviewed, and R1’s records were reviewed. LPA also reviewed email documentation provided by R1’s family, the complainant, and the Administrator. A subsequent visit was conducted on 08/07/2025, from 11:20 a.m. to 12:30 p.m., to conduct additional interviews. According to documentation reviewed, multiple email communications occurred between the Administrator and R1’s family. (Cont'd LIC9099C - page 2) The Administrator also informed R1 that the shared room could potentially be rented to another resident, and R1 acknowledged and accepted this possibility. Although it was noted that R1 has a (POA) for financial and health decisions, R1 independently chose to remain in the shared room, exercising R1’s personal rights. As such, there was no requirement for staff to obtain POA consent regarding this personal decision. Based on interviews and documentation, there is insufficient evidence to support the allegation. The allegation is deemed Unsubstantiated. Exit interview conducted, and copy of report provided to Administrator. agreement for a private room but was temporarily relocated to a shared room due to facility renovations. It was alleged that R1 was charged an additional $1,100 for the shared room. The investigation determined that the Administrator did not provide proper notice of the rent increase and that there was no valid justification for the additional charge. A review of R1’s admission agreement showed that the additional services listed in the rent increase notice were already included as basic services. LPA also reviewed the facility’s admission policy, which states that rent increase notices must be issued annually and must not include costs for additional services. Review of R1’s records and the rental increase notice confirmed that the notice included not only the rent increase amount but also charges for additional services. There was no updated or current reappraisal to verify significant changes in R1’s level of care that would justify an additional increase in rent. Based on interviews and record review, it was determined that the Licensee/Administrator did not follow the facility’s admission policies, admission agreement, or procedures regarding annual rent increases. Therefore, the allegation is SUBSTANTIATED. Exit interview conducted and copy of report provided to staff.the state’s words, verbatim · CDSS document, Oct 7, 2025 · control 31-AS-20250310120257

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.655(a) · Plan of correction due date: Oct 28, 2025

§1569.655 Increase in fee rates for elderly residents; 60 days’ written notice stating amount of and reasons for increase; application of section.(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services ... notice to the residents or the residents’ representatives setting forth the amount of the increase and...reasons for the increase, including a description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This requirement was not met, evidenced by, based on documentation reviewed and interviews, the Administrator did not give a proper notice rental increase to (R1's) POA nor did he not follow the facility’s admission policies, admission agreement, or procedures regarding annual rent increases.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: Licensee shall review and revise facility procedures to ensure all future rate increases comply with Title 22 requirements, including providing residents with at least 60 days written notice and excluding any services already listed as part of the basic rate. Licensee shall submit proof of revised admission agreement templates and rent increase notification procedures to CCLD by 10/28/2025.

Allegation investigated: .Staff are not qualified to administer medication to residents 2.Staff did not administer medications as prescribed

Licensing Program Analyst (LPA) Tuesday Cabiness arrived to the facility at 10:27am to conduct a subsequent visit and deliver the final findings and report. LPA met with Administrator Mario Gurule and informed him the reason of the visit. The following was determined: Allegation #1: .Staff are not qualified to administer medication to residents. To investigate the allegation, on 07/09/2025, from 10:00 a.m. to 11:00 a.m., LPA interviewed the complainant and reviewed the complaint. On 07/10/2025, from 9:15 a.m. to 1:45 p.m., LPA conducted an unannounced visit to the facility, interviewed staff and residents, and reviewed resident and facility documentation. Information obtained during the investigation revealed concerns that staff were hesitant to administer narcotic medication to resident #1 (R1), and it was reported that staff refused to provide pain medication that was scheduled. However, staff interviews indicated that although R1 was in extreme pain due to a medical diagnosis, staff administered the prescribed medication in accordance with physician orders to alleviate the resident’s discomfort. Staff acknowledged the emotional difficulty of witnessing a resident in severe pain but affirmed their understanding of their responsibilities as Unsubstantiated caregivers to provide appropriate care. Staff interviewed have been employed at the facility for over four years and reported no prior issues related to medication administration. Residents interviewed also stated that staff consistently administer medication without any problems. LPA reviewed staff medication training records, which were observed to be current and up to date. Based on interviews conducted and documentation reviewed, there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Allegation # 2: Staff did not administer medications as prescribed. To investigate the allegation, on 07/09/2025, from 10:00 a.m. to 11:00 a.m., (LPA) interviewed the complainant and reviewed the complaint. On 07/10/2025, from 9:15 a.m. to 1:45 p.m., LPA conducted an unannounced visit to the facility, interviewed staff and residents, and reviewed resident and facility documentation. Information obtained during the investigation revealed that resident #1 (R1) was admitted to the facility on 06/22/2025 under hospice care due to a terminal illness. According to the resident’s medication records, staff administered R1’s medications in accordance with the physician’s orders. After five days at the facility, R1’s condition began to decline, prompting the physician to update the medication orders. Documentation reviewed from both facility/staff records and hospice records confirmed that staff continued to administer medications as prescribed by the attending physician. Additionally, residents interviewed by LPA reported receiving their medications without any issues. Based on interviews and a review of documentation, there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Jul 15, 2025 · control 31-AS-20250630114223

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an annual inspection, LPA was greeted by caregiver Nazrul Sekh, who allowed LPA to enter. There was (1) additional staff on duty, and the Administrator Mario Gurule was contacted and on the way to the facility. The current census is (3). Facility license/sketch, grievance/complaint procedures, personal rights, Infection/Mitigation plan, Administrator certificate, emergency disaster plan, COVID/hand-washing signs, and complaint procedures was visibly posted. A physical plant tour of the facility inside and outside was conducted with staff. The following common areas: living, dining, kitchen, resident bedrooms, and bathrooms were inspected to ensure the facility was in compliance with Title 22 Regulations: Kitchen: LPA observed a Licensing requirement of (7) day nonperishable, and (2) perishable, with extra refrigerator and freezer stocked with food in the garage. Food was properly wrapped, and appliances were functional, clean, and in good repair. Chemicals, household supplies, and knives, that are stored in the kitchen and garage area were locked and secured. Living/dining: All indoor passageways were free from obstruction; inside temperature was comfortable, with adequate lighting, and all areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (5) bedrooms; with (1) room for staff. All bedrooms were properly furnished and supplied with appropriate bedding and linens. There were sufficient linens observed and available; as well as personal hygiene products available for residents. Bathrooms: There are (2); all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured at degrees 119.5 Fahrenheit. Surrounding Grounds: There were no visible hazards; passageways were free from obstruction and gates were easily accessible to open. All exit doors have alarms; all were operating. Fire extinguisher was checked. First aid kit furnished fully equipped. Smoke alarms and carbon monoxide detectors were tested and operating properly. Record review: Staff was missing medication and current training records. Residents: All required documents observed in file and current. Citations issued, appeal rights, and copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Feb 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an annual inspection, LPA was greeted by caregiver Nazrul Sekh, who allowed LPA to enter. There was (1) additional staff on duty, and the Administrator Mario Gurule was present during the visit. The current census is (4). Facility license/sketch, grievance/complaint procedures, personal rights, Infection/Mitigation plan, Administrator certificate, emergency disaster plan, COVID/hand-washing signs, and complaint procedures was visibly posted. A physical plant tour of the facility inside and outside was conducted with Administrator Mario Gurule. The following common areas: living, dining, kitchen, resident bedrooms, and bathrooms were inspected to ensure the facility was in compliance with Title 22 Regulations: Kitchen: LPA observed a Licensing requirement of (7) day nonperishable, and (2) perishable, with extra refrigerator and freezer stocked with food in the garage. Food was properly wrapped, and appliances were functional, clean, and in good repair. Chemicals, household supplies, and knives, that are stored in the kitchen and garage area were locked and secured. Living/dining: All indoor passageways were free from obstruction; inside temperature was comfortable, with adequate lighting, and all areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (5) bedrooms; with (1) room for staff. All bedrooms were properly furnished and supplied with appropriate bedding and linens. There were sufficient linens observed and available; as well as personal hygiene products available for residents as well. Bathrooms: There are (2); all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured at 120.0 degrees Fahrenheit. Surrounding Grounds: There were no visible hazards; passageways were free from obstruction and gates were easily accessible to open. There was no swimming pools or other bodies of water. All exit doors have alarms; all were operating. Fire extinguisher was checked. First aid kit furnished fully equipped. Smoke alarms and carbon monoxide detectors were tested and operating properly. Record review: A complete record review of staff and residents were conducted. All required documents in files. Infection/Mitigation Control Review: The common areas were observed to be clean, including resident rooms, and staff and visitor bathrooms. Soap and towels, and hand washing signs were visually posted. The facility has cleaning procedures and protocols in place, which include staff cleaning common areas throughout the day. The facility has documentation of all vaccination records for staff and residents. Temperature check and cleaning station located at the front door. No citation issued, exit interview and copy of report provided.the state’s words, verbatim · CDSS document, Mar 7, 2024