Maple Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility to conduct an annual licensing inspection. LPA met with Snezana Djukic, Administrator, and discussed the purpose of the visit. A tour of the facility was conducted inside and out. LPA, accompanied by the Administrator, conducted a general overall inspection, which included but was not limited to the following: Facility physical plant, food service, medication management, record review and facility administration. The facility is licensed to serve thirty-one (31) elderly residents ages 60 years and above all of whom may be non-ambulatory. A Hospice waiver is approved for two (2) residents. LPA conducted resident and staff interviews. During today's inspection, LPA observed the following: Indoor and outdoor passageways were observed to be free from obstruction. There are no pools or bodies of water. Per Administrator, there are no firearms or other dangerous weapons in the facility. Poisons and cleaning agents were observed to be secured and inaccessible to residents in care. Facility fire clearance is maintained in conformity with State Fire Marshal regulations. LPA toured random rooms in the facility. Resident rooms had the required furnishings and sufficient lighting available. The hot water temperature measured at 107.9 degrees F. The facility has functioning carbon monoxide detectors, multiple smoke detectors, and multiple operable fire extinguishers. The facility was stocked with a two-day supply of perishable food items and a seven-day supply of nonperishable food items. Staff records were reviewed and contained CPR/First Aid training, Health Screening Reports, and annual training. Resident records were reviewed and had a current Physician's Report, Resident Appraisal, Identification and Emergency Information, Admission Agreement, and Centrally Stored Medication and Destruction Records. Medications were stored in a locked medication room and were labeled and maintained in compliance with label instructions. The last drill was held on 8/20/2023 and drills are conducted quarterly. No deficiencies were observed during today's visit. This report was discussed with Administrator. A copy of this report, along with Licensee/Appeal Rights, was provided sat the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 12, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Chinwe Nwogene made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA met with Administrator, Snezana Djukic and Director, John Djukic who was informed of the purpose of the visit. At the time of visit there was 3 staff and 16 residents present. The facility currently has zero positive or suspected Covid-19 cases. During today's visit, LPA toured the facility inside and out with Snezana and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer and paper towels) in all restrooms. LPA did not observe any pools or bodies of water within the premises. LPA was informed that no weapons or ammunition is maintained at the home. No annual fees due. The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks. The Facility will contact the resident's physician should there be any event of COVID-19 related illnesses. The facility has a designated infection control lead. The facility also cleans and disinfects the highly touched surfaces during each shift, and as needed. LPA observed PPE supplies. No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Snezana Djukic.the state’s words, verbatim · CDSS document, Oct 17, 2022

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Natasha Persaud and Kayla Hilario conducted an unannounced annual required licensing inspection. LPAs were greeted and allowed entry into the facility by staff, Lidia Esquivel. LPAs met with Administrator, Snezana Djukic and Director John Djukic. LPAs stated purpose of today’s visit, to verify compliance with statutes, regulations and other written requirements that are most relevant to protecting the health of residents in care and staff, including in the area of infection control practices. During today’s visit, LPAs toured the facility and reviewed the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report (LIC 808) with Administrator including the following sections: Person in Care; Staff; Visitors; Residents; Facilities without COVID-19; and Facility has Plans for Infection Control and Physical Distancing. LPAs assessed the strategies that the facility is employing for the prevention, containment and mitigation of COVID-19, implementation of infection control guidance, staff retention and essential health and safety. LPAs observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, residents and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff and residents; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE. The facility is in compliance with and has implemented infection control practices as outlined in its LIC 808. No deficiencies were observed during today’s visit. An exit interview was conducted, and a copy of this report and Licensee Rights (LIC 9058 01/16) were provided to Administrator via electronic mail. An electronic mail read receipt was requested to be provided upon receipt of the documents..the state’s words, verbatim · CDSS document, Oct 12, 2021

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Eva Torres conducted a case management visit to amend a report that was created on 05/05/20. LPA Torres met with Administrator, Djukic Snezana, and informed them of the purpose of the visit. During the visit, LPA issued the amended report. An exit interview was conducted with the administrator, and the Licensee’s Rights (LIC9058 01/16) along with a copy of this report was emailed to them. A reply email or return receipt from the administrator will confirm receipt of documents.the state’s words, verbatim · CDSS document, Jul 26, 2021

Allegation investigated: Licensee violated Resident's #1 personal rights

Licensing Program Analyst (LPA), Eva Torres initiated a virtual visit to investigate the above allegation, due to COVID-19. LPA identified herself and discussed the purpose of the phone call with Administrator, Djukic Snezana. The investigation included interviews with staff and resident's responsible parties. It was alleged that the licensee violated Resident #1's (R1) (See Confidential Names List, LIC811 for R1) personal rights by preventing them from speaking with their family. The investigation revealed that the facility’s landline is being used more often than normal due to COVID-19. As a result, the licensee provided all residents and their responsible parties with an alternative phone number for anyone attempting to reached residents during normal business hours. Moreover, the interviews conducted with staff and the resident’s responsible parties did not support the allegation, as they confirmed they were always able to reach the facility using the mainline and, or the alternative number. Also, the reporting party confirmed that they were able to schedule a meeting with R1 using the mainline and the alternative number. Unsubstantiated Though the investigation revealed that the facility experience a temporary phone disruption as a result of the phone company working on the phone line, interviews did not reveal the licensee prevented incoming phone calls. Based on the investigation, the Department deemed the evidence insufficient in proving or disproving the allegation occurred. Therefore, the complaint investigation findings are found to be unsubstantiated. An exit interview was conducted with the administrator, and the Licensee’s Rights (LIC9058 01/16) along with a copy of this report was provided to Administrator, Snezana via email. A reply email or return receipt from the administrator will confirm receipt of documents. This is an amended version of the original report that was created on 05/05/20.the state’s words, verbatim · CDSS document, May 5, 2020 · control 08-AS-20200428160752