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Allegation investigated: Staff asked resident inappropriate question(s). Staff left resident in soiled clothing for an extended period of time.

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. It was alleged staff asked resident inappropriate questions and staff left resident in soiled clothing for an extended period of time. During the investigation, LPA conducted interviews with staff and residents in care. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation staff asked resident inappropriate questions, it was reported a staff member had asked Resident 1 (R1) if they wanted lotion to be rubbed in their private parts. LPA interviews with seven out of seven current and former staff stated that they have never witnessed or were made aware of any inappropriate conversations with residents. Five out of seven current and former staff stated R1 had a history of psychotic episodes and would act out aggressively towards staff. Unsubstantiated Four out of the five former and current staff added R1 punched a staff member while the staff member was assisting with a shower. Administrator AD Andreea Moldovan stated R1 moved away from the facility October of 2023. Interviews with two out of six residents stated their needs are being met and have never been spoken to inappropriately by staff. The remaining residents could not be qualified for interviews. Record review revealed R1 was diagnosed with a schizoaffective disorder and a mild cognitive impairment. Four out of four current staff have completed personal rights training. Three out of four current staff have signed mandated reporter acknowledgements. Regarding the allegation staff left resident in soiled clothing for an extended period of time, it was reported R1 was left soiled in a diaper for a period of time. Interviews with five out of seven former and current staff stated residents are checked for incontinence care needs two to three times per shift or more as needed. One out of those five staff stated R1 was able to communicate their needs when needing to use the bathroom. The remaining two staff did not add anything relevant to this allegation. Interviews with two out of six residents stated they get assistance with incontinence care. The remaining four residents could not be qualified for interviews. Record review revealed R1's physician report stated R1 could communicate needs. Based on resident interviews, staff interviews and records observed, the allegations of staff asked resident inappropriate questions and staff left resident in soiled clothing for an extended period of time are therefore deemed unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of the report was left with the facility representative.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 22-AS-20210202163808

Type of visit: Required - 1 Year

On May 28, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator (AD) Natalia Surgent arrived shortly after and was present to assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for three (3) residents. Currently, there are three (3) Hospice residents present during today’s visit. This is a single story with a attached garage facility. The facility has six private bedrooms, three full bathrooms and one caregiver room. At around 1:30PM, LPA conducted a tour of the physical plant accompanied by Administrator Natalia Surgent, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 112.4 to 116.0 degrees F. A comfortable temperature of 72 degrees F. was maintained in the facility. LPA Tirre observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has emergency food and water supply. Facility has two fire extinguishers which were mounted and fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. CONTINUED ON 809C During the visit, LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed all mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on April 10, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 12/31/24 – 12/31/25. A review of Five residents (R1-R5) service files and two staff (S1-S2) personnel files revealed to be complete. The facility has the current administrator's certification on file for Natalia Surgent # 7008870740 - Expiration 2/10/2026 No deficiencies during this inspection visit. An exit interview was conducted with Administrator Surgent, and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by care giver David Pakpahan to whom LPA discussed the purpose of the visit.. LPA also discussed the purpose of the visit with Licensee/Administrator Natalia Surgent who accompanied LPA on tour. According to the facility’s license, the facility has a maximum capacity of six (6) non-ambulatory clients. Facility also has a hospice waiver for 3. LPA, accompanied Licensee/Administrator Natalia Surgent, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was compliant. Hot water temperature at taps accessible to clients were all compliant. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Centrally stored medications were properly stored and locked in medication cabinet.. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions. [Continued on 809-C] [Continued from 809] No pools or bodies of water on the premises. Per Licensee/Administrator Natalia Surgent , no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed the theft and loss policy and procedures. Transportation procedures are compliant. Administrator’s certification is current. LPA interviewed staff members and Residents. LPA interviews did not raise any licensing concerns. Staff and resident records review verified that all staff records and residents are complete and compliant. Licensee presented proof of current liability insurance. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. An exit interview was conducted with Licensee/Administrator Natalia Surgent, to whom copies of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 15, 2024