Abundant Care II

Type of visit: Required - 1 Year

At 9:00am on 12/19/2025, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to conduct the facility annual inspection. LPA met with Designated Administrator Lida Kravchuk, who is an Administrator at Licensees other facilities, announced who he is and the reason for the visit. This facility is a 7 bedrooms, all single client occupancy, 1 bedroom is a designated staff bedroom, 6 bathroom, with 5 on-suite bathrooms and one community bathroom, living room, dining room, kitchen, with a fenced yard with seating, umbrella, and a pergola that can be used for resident activities, visiting and lounging. Each resident room has proper furniture, storage, and linin to meet regulation requirements.LPA observed dual smoke and carbon monoxide detectors through out the facility that are hardwired and functioning properly. LPA observed a working fire extinguisher that was primed in the green in the facility entrance. LPA noted that the facility first aide kit in the same location as the fire extinguisher. LPA observed the medication cabinet in the kitchen to be locked and secured, LPA noted that the facility has at least two days of perishable foods and at least seven days of non perishable foods on hand for six residents and staff. LPA reviewed Emergency Disaster Plan, Infection Control Plan, Liability Insurance, and documented emergency disaster drill logs. LPA reviewed a sample of staff files and resident files. LPA conducted a cursory audit of Central Stored Medication Records (CSMR). LPA reviewed staff training and Facility Plan of Operations. LPA noted that there were no violations or citations as part of the facility physical inspection. Designated Administrator and LPA conducted a full review of the annual care tools and noted no violations or citations. LPA noted no violations or citations as a result of this annual facility inspection. Exit interview, report read, and report provided.the state’s words, verbatim · CDSS document, Dec 19, 2025

Type of visit: Required - 1 Year

On 01/03/2025, Licensing Program Analyst (LPA) Brian Phillips arrived at the facility above to conduct an unannounced annual facility evaluation visit. When the LPA arrived, they were greeted by Licensee Timothy Pryko and Assistant Administrator Valerija Bohonko. LPA informed facility representative of the reason for the visit upon entry. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. This is a Residential Care Facility for the Elderly (RCFE), with an approved fire clearance capacity of six (6) non-ambulatory residents. The facility has an approved Hospice Waiver for three (3) residents. The LPA inspected the food service area in the facility and observed that items which could constitute a danger to residents are kept inaccessible to residents. All appliances were in operable condition and looked clean/in good repair. Appliances such as microwaves, refrigerators, stoves, etc. are clean and operating properly. Food utensils, dishes, glasses, etc. are clean and in good repair with no cracks or chips. There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. LPA observed an appropriate/adequate amount of perishable and non-perishable food items maintained in the facility. Furniture is room/resident appropriate, clean and in good repair. All rooms are appropriately furnished for their intended use such as bedrooms, common areas, etc. Hot water temperature is maintained between 105-120 degrees Fahrenheit as per Community Care Licensing (CCL) Title 22 regulations. Outdoor activity spaces have shaded areas and furnished for outdoor use. Each resident has an adult bed with a mattress, pad, bedsprings, and pillow, which are clean and in good repair. Each bed is fitted with sheets, pillowcase, blankets, and bedspread that are clean and in good repair. Each resident has adequate dresser and closet space for clothing and other belongings that includes at least two drawers or adequate dresser space. The facility has a sufficient supply of linens to permit weekly changing or more often to always ensure clean linens for residents. Equipment and supplies for resident personal hygiene is available and on site. Activity supplies are available for residents. Continued on 809-C As the facility has an approved fire clearance for a maximum capacity of six (6) residents, no signal system was observed by LPA nor required by the Licensing Agency. Refrigerators and freezers are maintained at an appropriate temperature Fahrenheit as per CCL regulations. Food storage and preparation areas are clean and appropriate for food preparation. The food service areas are clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. Cleaning supplies are kept in areas separate from where food supplies are stored. Walls, ceilings, floors, carpeting, window screens, and areas around the facility are clean, painted and/or in good repair. There are locked storage area(s) for poisons, toxic, cleaning solutions, disinfectants, etc. Fire extinguishers and smoke detectors operate properly. Doors and passageways are unobstructed. There are no pools/bodies of water on the physical plant of the facility as observed by LPA. During the inspection, LPA did not observe any firearms that would require trigger locks, locked and inaccessible, or firing pins removed. The physical plant of the facility contains a living room, kitchen, dining room, indoor hallway/passageways, live-in Staff room, and six (6) private resident bedrooms available for individual residents. No resident shares a bedroom, and each bedroom has a private restroom. The live-in staff room is off the hallway of the facility and always remains locked, inaccessible to residents. The facility contains an outside area for residents to utilize for outdoor activities/outdoor visitations and an outdoor patio/gazebo area with furniture and shade. At the time of the visit, all common areas/interior rooms of the facility were observed to be appropriately furnished, with all furniture in good condition. The facility common areas include communal restrooms in the hallways, resident bedrooms, a resident activity room, locked laundry room, locked/staff only kitchen area, dining room, locked food storage/pantry, locked closet areas in the hallways containing the storage of clean linens, PPE materials, resident hygiene products, and activity materials. The LPA observed required postings throughout the common spaces including Resident Personal Rights and Contact information for Ombudsman as well as Licensing. There are activity supplies and equipment, including activity materials for the residents. All window screens were in good repair. There is appropriate lighting in the common areas of the facility. All passageways through the common areas of the facility were free of obstruction, and as the facility is one (1) story, there are no stairwells/stairs for resident use. Carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were fully charged and serviced annually. The facility maintained a comfortable temperature in all areas inspected. LPA did not observe any noticeable outdoor hazards. Outdoor activity spaces in the facility are shaded and equipped with furniture for resident use. The facility maintains the use of electronic combination locks on areas inaccessible to residents. Continued on 809-C The facility has adequate storage of additional supplies/emergency supplies. The designated laundry area in the facility has appropriate storage of cleaning products, which are kept locked and inaccessible to residents. Emergency food and water in storage were observed to be in good condition by the LPA. The laundry area is in a locked addendum/room area off the main hallway of the facility that is inaccessible to residents. There is a main entrance walkway into the facility and an administrative entrance area for visitors. The front yard is well maintained and consists of walkways and garden areas. The backyard is well maintained and has a paved patio, gazebo, and garden areas with walkways surrounding the parameter of the facility. The backyard is conducive for outdoor visitation. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The exterior of the facility has a closed perimeter which consists of a wall around the entire facility with latched gates. Inside of the perimeter is the outdoor/outside activity area for residents with a gazebo/patio in the backyard, furniture, shade, multiple small sheds that are locked and contain outdoor maintenance materials and the water softener for the facility, as well as the emergency generator and emergency supplies for the facility. LPA was shown the inside of all sheds upon request. There are also two (2) detached buildings in the backyard/outdoor area of the facility that consist of a Staff member break room and a Staff member private kitchen. These buildings are always locked and inaccessible to residents. The facility restrooms were sanitized and in operating condition while the LPA toured the facility. All restrooms in the facility were sufficiently stocked with soap, paper towels, required postings, and clean trashcans with closed lids. Towels and washcloths are not shared by residents in the facility. The hot water temperature was measured in the restrooms at the appropriate degrees Fahrenheit as per Title 22 regulations between 105-120 degrees Fahrenheit. All toilets and hand washing areas are maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences are available accommodate any physically handicapped residents who need such items. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Each resident bedroom has a bed, nightstands, and lights and nightstand lamps to provide sufficient lighting. Each closet in all the resident rooms can store or has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any resident. The resident bedrooms are big enough for all beds, furniture, and any resident assisting device a resident might need such as a wheelchair or a walker. Each room has sufficient lighting for each resident. The facility has provisioned to each resident of furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. All restrooms in the facility are in the interior of each individual resident bedroom. Continued on 809-C An emergency exiting plan and emergency phone numbers are posted in an appropriate place. First-aid supplies, which include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual, are maintained. Administrator’s records, employees and resident records are maintained at the facility and available for review by the LPA as employees are hired and residents accepted into the facility. The facility complies with CCL standards for health screening, TB clearance, staff training, criminal background clearance and transfer requests. Admission agreements and needs and services (ANS) plan are maintained for each resident and/or their authorized representative. Resident records are maintained on the facility premises in a secured area. Centrally stored medications are locked inaccessible to residents. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record. The facility administrator meets the qualifications as specified in Title 22 regulations with an active RCFE administrator certificate that expires on 04/20/2025. Provider Information Notices are available and able to be presented to Staff, residents, visitors, and accessible to LPA upon request during the inspection process. Exit interview conducted by LPA. Copy of this report provided to the facility.the state’s words, verbatim · CDSS document, Jan 3, 2025

Type of visit: Required - 1 Year

On 01/25/2024, Licensing Program Analyst (LPA) Brian Phillips arrived unannounced for an unscheduled visit to conduct a required Annual Facility site inspection visit at the facility above. When the LPA arrived, they were greeted by Co-Administrator/Licensee Timothy Pryko and Co-Administrator Valerija Bohonko, and informed them of the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. This is a Residential Care Facility for the Elderly (RCFE), with an approved fire clearance capacity of six (6) residents. The facility is approved for six (6) non-ambulatory residents with a Dementia diagnosis. The facility has an approved Hospice Waiver for three (3) residents. The physical plant of the facility contains a living room, kitchen, dining room, indoor hallway/passageways, live-in Staff room, and six (6) private resident bedrooms available for individual residents. No resident shares a bedroom, and each bedroom has a private restroom. The live-in staff room is off the hallway of the facility and always remains locked, inaccessible to residents. The facility contains an outside area for residents to utilize for outdoor activities/outdoor visitations and an outdoor patio/gazebo area with furniture and shade. KITCHEN: The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in a locked drawer inaccessible to residents. Kitchen appliances were in operable condition and looked clean/in good repair. The LPA observed perishable items in good condition, with proper expiration dates precluding the perishable items from expiring. The facility has a sufficient supply of perishable and non-perishable food, which would last over a week (7 days). Additional perishable food items were maintained in a storage area in a locked cabinet in the kitchen area of the facility as well as an extra refrigerator and extra freezer located in a locked room/addendum off of the hallway of the facility. The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation between 105-120 degrees Fahrenheit. Items that could constitute a danger to residents are kept inaccessible to residents in the kitchen area. Continued on 809-C The kitchen was clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. The freezer and refrigerator were both in the appropriate temperate Fahrenheit. There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. COMMON AREAS: At the time of the visit, the common areas of the facility were observed to be appropriately furnished, with all furniture in good condition. There is a fireplace in the facility, located in the living room of the facility that is covered an inaccessible to residents. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector(s) were operational at the time of the visit. The facility has multiple fire extinguishers that were fully charged and serviced annually, all being tagged as serviced in 2023. This is a single-story facility with a main living room area, kitchen area, dining room, laundry room, 6 resident bedrooms, 6 resident restrooms, a locked centrally stored medication containment area, extra storage areas for additional perishable food, cupboards in the hallways of the facility containing extra linen/bedsheets/pillows, and storage areas for resident personal hygiene equipment constituting the interior areas of the facility. The LPA observed required postings throughout the common spaces including Resident Personal Rights and Contact information for Ombudsman as well as Licensing. There are activity supplies and equipment, including activity materials for the residents such as television, puzzles, games, etc. All window screens were in good repair. There is appropriate lighting in the common areas of the facility. All passageways through the common areas of the facility were free of obstruction, and all inclines are well-lit with no stairwells/stairs for resident use. The laundry area for the facility is located in a locked addendum/room area off of the main hallway of the facility that is inaccessible to residents. There is a main entrance walkway into the facility and an administrative entrance area for visitors. The facility has electronic auditory systems on all doors that can exit the interior of the facility, with a loud noise when a door exiting the facility is opened. The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Hallways, bedroom doors, and walls are in good repair. OUTSIDE/LAUNDRY/MISCELLANEOUS: The front yard is well maintained and consists of walkways and garden areas. The backyard is well maintained and has a paved patio, gazebo, and garden areas with walkways surrounding the parameter of the facility. The backyard is conducive for outdoor visitation. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The exterior of the facility has a closed perimeter which consists of a wall around the entire facility with latched gates. Continued on 809-C Inside of the perimeter is the outdoor/outside activity area for residents with a gazebo/patio in the backyard, furniture, shade, multiple small sheds that are locked and contain outdoor maintenance materials and the water softener for the facility, as well as the emergency generator and emergency supplies for the facility. LPA was shown the inside of all sheds upon request. There are also two (2) detached buildings in the backyard/outdoor area of the facility that consist of a Staff member break room and a Staff member private kitchen. These buildings are always locked and inaccessible to residents. The facility has an outdoor activity area that is provided with a shaded area and furnished for outdoor use. There are no bodies of water noted on the facility property. The facility has a small fountain in the backyard, but it contains no water and is filled with stones. The designated laundry area is a locked room within the facility, and there is another locked closet area within the main facility that is where cleaning products are stored, which are kept locked and inaccessible to residents. The laundry room is always locked and accessible through the hallway of the facility, next to another locked area which has all hazardous items locked with electronic combination locks. Staff members are the only individuals allowed to do laundry and the entire room is kept locked at all times. There was emergency food and water in a storage area in the interior of the facility and in the extra perishable food storage area which was observed to be in good condition. Cleaning supplies, disinfectants, and other items that could pose a danger to residents are kept in areas inaccessible to residents. There is a first aid kit that includes sterile dressings, bandages, thermometers, scissors, tweezers, and a first aid manual. The vehicles used to transport residents are in safe operating condition with appropriate insurance information. LPA did not observe any noticeable outdoor hazards in areas accessible to residents. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There are six (6) designated resident rooms in the facility with one (1) individual resident per bedroom. The bedrooms have storage areas for clean linens, towels, pillows, etc. Each resident’s bedroom has a single bed, nightstand, and lights/nightstand lamps to provide sufficient lighting. Each closet in all the resident rooms has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any resident. The resident bedrooms are big enough for all beds, furniture, and any resident assistive device a resident might need such as a wheelchair or a walker. Each room has sufficient lighting for each resident. All resident bedrooms contain their own private restroom within the bedroom area. All resident bedrooms contain sliding doors to the exterior of the facility, monitored by the auditory system in place by the facility that alerts Staff when a door exiting the facility has been opened. Continued on 809-C RESTROOMS: The facility restrooms were sanitized and in operating condition while the LPA toured the facility. There are six (6) resident restrooms in the facility. All restrooms inspected had assistive equipment for residents including grab bars and/or non-skid surfaces. The restrooms were sufficiently stocked with soap, paper towels, and additional supplies; towels and washcloths are not shared. The hot water temperature was measured in the restrooms at the appropriate degrees Fahrenheit as per the regulations between 105-120 degrees Fahrenheit. Nightlights are installed in the hallways outside of the resident restrooms. The facility maintains private, personal restrooms for residents in each resident bedroom. All resident bedrooms have their own private restroom consisting of a sink, toilet, and bath/shower. RECORDS: The facility keeps confidential storage of resident records as well as Staff member records on-site at the facility. Staff member records were reviewed for, but not limited to Personnel records, Health assessments/screenings with Tuberculosis (TB) test results, Personnel Action Notice, Job Description with date of employment, Employee Rights, Criminal record Statements/Criminal record clearances, first aid/CPR certification that is not expired, appropriate training, and Abuse Reporting Requirements. All staff members’ personnel records had the appropriate documentation with no expiration of any training. All three (3) Co-Administrators Certificates are current/valid. Resident records were reviewed for Pre-Admission/Placement appraisals, Admission Agreements, Physicians Reports with TB Clearance, Consent Forms, Personal Rights for Residents, Emergency Information, Release of Medical Information, Needs and Services Plan (ANS)/Resident Care Plan Report with Updates, Resident Assessments, Physician Orders for Life Sustaining Treatment (POLST), Responsible Person or Conservator of Resident, Self-management of medications if applicable, Medication Orders, Medication Logs, and Inventory of Personal Effects/Management of Resident Cash and/or Valuables/Property. The facility also keeps records of resident vital signs and a resident weight record for all resident files reviewed. All resident records reviewed by the LPA had the appropriate documentation with no missing or incomplete information. MEDICATIONS: The facility maintains a locked centralized storage area for resident medications. Centrally Stored Medications are in a locked storage containment area within the kitchen area of the facility, which is a set of cabinets that remain locked at all times, inaccessible/locked to residents. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record, The Medication Administration Record, and the record of Controlled Medications. LPA audited the medications for residents and noticed no irregularities or issues concerning the dispensing of medications or the logging of medications. The medications in the facility were labeled appropriately with no additional or prohibited markings by the facility. Continued on 809-C INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening and a sanitation station. The staff members will keep up signs that promote good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exit plans with necessary telephone numbers. The facility keeps hard copies of facility documentation such as Facility Personnel Report, Emergency Disaster Plan for Residential Care Facilities for the Elderly (RCFE), Facility Infection Control Plan/Mitigation Plan, Certificate of Liability Insurance, Valid Administrator Certificate, Facility License, and a Facility Sketch. Provider Information Notices are available and able to be presented to Staff, residents, visitors, and accessible to LPA upon request during the inspection process. No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.the state’s words, verbatim · CDSS document, Jan 25, 2024