Abundant Care III

Type of visit: Required - 1 Year

At 9:00am on 07/21/2026, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to conduct the facility annual inspection. LPA met with Designated Administrator Timothy Pryko, announced who he is and the reason for the visit. This facility is an expansive 7 bedroom, 8 bathroom, living room, dining room, kitchen, laundry room, with a fenced front and side yard and a in back yard court yard with seating, umbrella, and a pergola that can be used for resident activities, visiting and lounging. There are six single occupancy resident rooms, all with on suite bathrooms. Each room has proper furniture, storage, and linin to meet regulation requirements. The seventh bedroom is a staff bedroom with on suite bathroom and there is a single half bathroom for use of all resident, staff and visitors. LPA observed dual smoke and carbon monoxide detectors through out the facility that are hardwired and functioning properly. The facility has a build in indoor sprinkler system that passed pressure testing on May 19, 2026 by Nargoan Fire & Safety Company. LPA observed a working fire extinguisher that was primed in the reading near the courtyard exit. LPA observed a 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, Jul 23, 2026

Type of visit: Required - 1 Year

At 8:00am on 07/21/2025, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to conduct the facility annual inspection. LPA met with Designated Administrator Lida Kravchuk, announced who he is and the reason for the visit. This facility is an expansive 7 bedroom, 8 bathroom, living room, dining room, kitchen, laundry room, with a fenced front and side yard and a in back yard court yard with seating, umbrella, and a pergola that can be used for resident activities, visiting and lounging. There are six single occupancy resident rooms, all with on suite bathrooms. Each room has proper furniture, storage, and linin to meet regulation requirements. The seventh bedroom is a staff bedroom with on suite bathroom and there is a single half bathroom for use of all resident, staff and visitors. LPA observed dual smoke and carbon monoxide detectors through out the facility that are hardwired and functioning properly. The facility has a build in indoor sprinkler system that passed pressure testing on April 8, 2025 by Nargoan Fire & Safety Company. LPA observed a working fire extinguisher that was primed in the green reading near the courtyard exit. LPA observed a 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, Jul 21, 2025

Type of visit: Required - 1 Year

On 08/22/2024 Licensing Program Analyst (LPA) Brian Phillips arrived at the facility above for an unannounced visit to conduct a required Annual facility site inspection. The LPA was greeted by Administrator Lidia Kravchuk, 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 facility is in compliance with Title 22 Regulations. This is a Residential Care Facility for the Elderly (RCFE) with an approved fire clearance for six (6) residents. The facility was observed by the LPA to be clean, safe, sanitary and in good repair for the safety and well-being of residents, employees, and visitors. The facility has provisioned to each resident of furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. There are currently six (6) residents in care at the facility, with two (2) residents currently receiving Hospice home health care services. KITCHEN: The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored 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 as observed by LPA. Additional perishable food items were maintained in storage areas in the facility. The hot water temperature was measured in the kitchen at an appropriate temperature as per Community Care Licensing (CCL) regulations. Items that could constitute a danger to residents are kept inaccessible to residents in the kitchen area. 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. There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. Continued on 809-C COMMON AREAS: At the time of the visit, all interior common areas of the facility were observed to be appropriately furnished, with all furniture in good condition. There are three (3) fireplaces in the facility, all covered and inaccessible to residents. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers were fully charged and serviced annually. The LPA observed required postings throughout the common spaces on both floors including Resident Personal Rights and Contact information for Ombudsman as well as Licensing. There are activity supplies and equipment, including reading 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 all stairways are well-lit with sturdy hand railings. There is adequate space available for storage of residents' personal belongings. Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to residents are stored inaccessible to residents. OUTSIDE/LAUNDRY/MISCELLANEOUS: The front outdoor area of the facility consists of concrete and grass areas with a completely enclosed metal fence/gate. The facility is contained by a metal fence with a gate that remains unlocked. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Outdoor activity spaces are completely enclosed by a fence and gates or walls. Outdoor activity spaces in the backyard are equipped with furniture for resident use including a patio with an umbrella for shade. All outdoor areas with stairways, inclines, ramps, or open porches have accessibility ramps for residents, are well-lit, and have hand railings/grab bars. There were no bodies of water noted. However there is a fountain in the backyard area, but with no water. There is a designated laundry room where cleaning products are stored, which is kept locked. The laundry room is accessible through the common area of the facility as an addendum to the kitchen area. There was emergency food and water in a storage room/area which was observed to be in good condition. The storage area is a locked shed in the backyard of the facility. There is also a detached caregiver building in the backyard of the facility. 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. 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. Each resident bedroom has a single bed, nightstands, and lights and nightstand lamps to provide sufficient lighting. Continued on 809-C Each closet in all the resident rooms has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any resident. All resident bedrooms have a private bathroom inside as well as a glass sliding door into the backyard area of the facility. 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. RESTROOMS: The facility restrooms were sanitized and in operating condition while the LPA toured the facility. There are six (6) private resident bathrooms in the interior of resident bedrooms. There is also one (1) shared bathroom in the common area of the facility. All restrooms inspected had assisting 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 CCL regulations. There is at least 1 toilet and sink for each 6 residents, and at least 1 bathtub/shower for each 6 residents. Night-lights are installed in the hallways outside of the common area restrooms. All toilets and hand washing areas are maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences are provided by the ADP to accommodate any physically handicapped residents who need such items. RECORDS: The facility keeps confidential storage of personnel records and resident records on-site at the facility. The facility administrator meets the qualifications as specified in Title 22 regulations. Additionally, the facility administrator receives and documents continuing education each year. Personnel records reviews were reviewed for, but not limited to Personnel records, Health assessments 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, and the appropriate training documentation. Resident records were reviewed for Pre-Admission/Placement appraisals, Admission Agreements, Physicians Reports, Consent Forms, Personal Rights for Residents, Emergency Information, Release of Medical Information, Needs and Services Plan (ANS)/Individual Program Plan (IPP), Resident Assessments, Self-management of medications if applicable, Medication Orders, and Medication Logs. The facility complies with Community Care Licensing (CCL) standards for health screening, TB clearance, staff training, criminal background clearance and transfer requests. Resident records including Admission agreements and Needs and Services plan are maintained for each Resident and/or their authorized representative. MEDICATIONS: The facility maintains a locked centralized storage area for medications. Contd. on 809-C The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record. Centrally Stored Medications are in a locked cabinets in the kitchen area of the facilityinaccessible to residents. 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. 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 postings throughout the facility, including emergency exit plans with necessary telephone numbers. The facility maintains documentation on site such as the Fire Department Clearance, Personnel Report, Plan of Operation, Emergency Disaster Plan, Facility Infection Control Plan/Mitigation Plan, Evacuation Procedures, Personal Rights of Residents, and a Facility Sketch. Provider Information Notices are available and able to be presented to Staff, residents, visitors, and accessible to LPA. Facility documentation is prominently posted in areas accessible to residents and their visitors. The facility has on file a Dementia Care Waiver and Hospice Care Waiver. This facility maintains a camera video surveillance system monitoring the outside areas of the facility as well as one camera located in the common area kitchen/living room of the facility. No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.the state’s words, verbatim · CDSS document, Aug 22, 2024

Allegation investigated: Staff did not issue a refund as required Staff are charging resident for services not rendered

Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Timothy Pryko and explained the purpose of the visit. During the investigation, LPA Kontilis conducted an initial visit on 12/12/2023 from 1:05pm to 4:00pm, toured the facility and obtained documents. LPA Rankin reviewed the documents, including R1’s admission agreement, Power of Attorney (POA) documents, invoices, emails, and copies of checks. During the investigation, it was discovered that Resident 1 (R1) had one person as Power of Attorney (POA) for healthcare decisions, a different person as POA for financial decisions, and a different person as the trustee of their estate, to manage financial decisions for their estate after R1’s death. Continued on 9099-C Unsubstantiated Trustee was interviewed, and Power of Attorney (POA) for financial was interviewed during the investigation. On the allegation: Staff did not issue a refund as required. It was alleged that the facility did not refund the resident’s estate after the resident passed away. The facility issued a refund of $1678.73 on 12/21/22 to R1’s financial POA, as this was the person listed in R1’s admission agreement to issue a refund check to in the event of R1’s death. The financial POA never cashed the check, and the check was ultimately reissued to R1’s trustee on 8/2/2023 in the same amount. An email dated 2/16/2023 from Administrator to trustee breaks down the refund that was issued. The administrator states there were 11 days of care provided in December 2022. Level I and Level II care prorated is $3905. R1’s personal belongings were removed on 12/14/2022. Per the admission agreement, the rate continues until all resident belongings were removed, which adds three more days and an amount of $1065. The facility charged Level III services for hospice residents at $100 per day which is noted in the admission agreement, which adds $1100. The facility also charged for one-on-one care for 7 days from 12/4/22 to 12/11/22, for 14 hours per day at a rate of $30/hour, which equaled $2940. This totals $9010. The facility also charged $1973 for removing, disposing and the installation of new carpet and padding. Additionally, the facility charged $1438.27 for drywall patching and painting the walls. Administrator was interviewed about these additional charges. Administrator stated the charges were invoiced due to damage sustained. R1 painted their nails by themselves daily, used polish remover, and then painted a new color each day. The nail polish spilled on the carpet regularly through R1’s stay. Administrator stated they discussed with the financial POA that the carpet would need to be replaced when R1 moves out, and POA agreed to the charges. Administrator also stated R1 damaged the wall with their recliner, and dented the wall a bit when they reclined in the chair. Administrator stated they also explained the wall damage to the financial POA, and they would charge to have the drywall fixed and repainted, and POA agreed. Continued on 9099-C Financial POA was interviewed and stated they agreed to the additional repair charges when the damage was brought to their attention. Financial POA asked the facility to send them an invoice and they paid it, because it was not normal wear and tear. R1 paid $14,100 for December 2022. The total cost incurred for care and damages was $12,421.27. The facility issued a refund of $1678.73. Based on the information obtained, the allegation is deemed Unsubstantiated at this time. On the allegation: Staff are charging resident for services not rendered. It was alleged that the facility increased Resident 1 (R1)’s monthly amount due to an increase in the level of care. The trustee for R1’s estate stated they were unaware of the increase. R1’s Admission Agreement was signed 3/7/2022 by R1 and their healthcare POA (authorized representative). The Admission Agreement states on pages 4 to 5 the care levels offered by the facility; Level I, Level II, and Level III. It states Level I is for more independent residents and is included in the basic services fee. Level II offers additional care such as transferring, incontinence care and/or assistance with feeding for an additional $500 per month. Level III is for residents who rely on staff for “extensive assistance” with activities of daily living. It also states hospice residents and bedridden care is considered Level III and states it will be an additional fee of $100 per day. R1 went onto hospice on 6/21/2022. However, the facility made a billing mistake and did not charge R1 the additional $100 per day hospice/Level III care fee until 11/30/2022 per an invoice reviewed. The invoice shows back-billing for additional charges due to the resident being on hospice from June 2022 through November 2022, totaling $19,400. Administrator stated he spoke with the healthcare POA and financial POA, and they knew R1 would be going on hospice and knew about the level of care changes and increase. Administrator stated they were fine with the extra fees based on the admission agreement that was signed. In November 2022, the licensee realized the billing error. Administrator stated they spoke to the healthcare POA about it, and they stated to go ahead and make an invoice. Administrator stated it was a clear clerical error. Continued on 9099-C Financial POA verified there had been a billing error. They stated they signed the original admission agreement with the resident and agreed to the hospice fee of $100 per day. A letter from facility was given to LPA Rankin stating that on 06/19/2022 a letter was signed by the Financial POA confirming and approving the additional $100 per day Hospice charge. In addition when R1 went on hospice they verbally discussed the extra charges and agreed to them as well, but did not realize they were not on the invoices. POA stated when the billing error was brought to their attention, they told the facility to send an invoice and they paid it. Financial POA stated they believed the facility took good care of R1. Based on the information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of report given.the state’s words, verbatim · CDSS document, May 29, 2024 · control 29-AS-20231208110833