Country Oaks Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Alex Molitvenik, Administrator. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (4) residents. (1) resident was watching television in the common area and (4) residents were resting in their rooms at the start of the inspection. There are (0) residents receiving hospice care. LPA and the Administrator toured the interior/exterior of the facility including common areas, (4) private resident bedrooms, (1) shared resident bedroom, (3) resident bathrooms, kitchen, office, staff and laundry area. LPA observed the facility to be clean, in good repair and odor-free. Bathrooms have the necessary grab bars, non-skid flooring, and hand-washing posters. LPA discussed how individual cloth towels must be used if multiple residents are using the bathroom. There is sufficient 2+day perishable supply of food and 7+day non-perishable supply of food. Sharps and toxins were locked in the kitchen and additional toxins are secured in the laundry area. Medications are secured. There are sufficient linens, blankets, and the First Aid kit contains scissors, tweezers, bandages and a thermometer. A new kit will be purchased containing ointments. The hot water measured 118*F in the kitchen. Inside temperature measured 74*F. The smoke/monoxide alarms are working, and all exit doors have a signal device. There are (2) unlocked exits, with signal alerts, in the backyard, and outdoor space with seating. All required postings are visible in the common area. LPA reviewed (2) resident files and (2) staff files- Files were organized and contained current paperwork. Medications/orders reviewed for (1) resident- no discrepancies noted. Staff is cleared/associated and has current First Aid/CPR and other required training. Updated insurance information obtained. Plan of Ops to be updated with updated Dementia regs (1/25). Administrator RCFE Cert # 7007506740 (exp 1/18/27). |There were no deficiencies observed. Exit interview. Copy of report provided to the Administratorthe state’s words, verbatim · CDSS document, Nov 5, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Alex Molitvenik, Administrator, and explained the reason for today's inspection. The facility is licensed for (6) non-ambulatory residents and has an approved hospice waiver for (4) residents. LPA observed all (4) residents to be resting in their rooms at the start of the inspection. Currently, there are (0) residents receiving hospice care. During today's inspection, LPA observed a home health nurse visit the care home to meet with one of the residents. LPA and the Administrator toured the interior/exterior of the facility including common areas, (4) private resident bedrooms, (1) shared resident bedroom, (3) resident bathrooms, kitchen, and laundry area. LPA observed the facility to be clean, in good repair and odor-free. Bathrooms have the necessary grab bars, non-skid flooring, paper towels, and hand-washing posters. There is sufficient 2+day perishable supply of food and 7+day non-perishable supply of food. Sharps, toxins and medications were locked in the kitchen. There are sufficient linens/blankets/incontinent/PPE supplies and a complete First Aid kit. There are (2) unlocked exits in the backyard and sufficient indoor/outdoor space with seating. There are no pools. Additional personal rights to be posted in the common area near the staffing schedule. The fire extinguisher was last serviced 10/18/24 and the smoke/monoxide alarms work. The hot water measured 118*F in the kitchen, and the inside temperature measured 77*F. All exit doors have a signal device. LPA reviewed (2) of (4) resident and medication files. Records were found to be organized and current. No discrepancies were noted. Facility to request an updated copy of medication orders if there have been changes. (2) of (2) staff files were reviewed. Staff have current First Aid/CPR certifications and are completing required training. RCRE Admin # 6024306740- (exp 1/18/25). There were no citations issued, but there are (2) Technical Violations being issued. Exit interview. Copy of report provided to the Administrator.the state’s words, verbatim · CDSS document, Nov 21, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with caregiver, Icelyn Allen, and explained purpose of inspection. Alex Molitvenik, Administrator, arrived at approximately 2:35 pm. The facility is licensed for (6) non-ambulatory residents and has an approved hospice waiver for (4) residents. LPA observed all residents to be resting in their rooms at the start of the inspection. LPA and the Administrator toured the interior and exterior of the facility including the common areas, (5) resident bedrooms, (3) resident bathrooms, kitchen, office, laundry area. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, non-skid flooring, paper towels. Administrator to post 20-second hand-washing poster by each sink. LPA observed sufficient 2+day perishable supply of food, including fresh produce, and 7+day non-perishable supply of food. Sharps, toxins and medications were locked in the kitchen. LPA observed sufficient linens/blankets/incontinent/PPE supplies, PPE, and a complete First Aid kit. The inside temperature was 75*F. Hot water temperature measured 105*F in the kitchen. The fire extinguisher was last serviced 11/6/23. Fire/smoke monoxide alarms are in working order. There are (2) unlocked exits in the backyard and plenty of outdoor/indoor space for activities. Required postings are posted. LPA reviewed (3) of (4) resident files- they were found to be organized and contain current documentation. Medications were reviewed for (2) residents and no discrepancies were noted. Documentation is maintained and meds are pre-poured only for the day. (1) of (2) staff files were reviewed. Staff has completed all initial training as required, and First Aid/CPR is current for both staff. Administrator certificate #6024306740- exp 1/18/25. Administrator to provide current copy of LIC308, LIC500, liability insurance and LIC9282 (Infection Control Plan) to the Department by 12/8/23. There are no deficiencies cited. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Nov 28, 2023

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection following the receipt of a death report on 11/21/23 for resident (R1). LPA met with caregiver, Icelyn Allen, who contacted Alek Molitvenik, Administrator, by phone. LPA and the administrator discussed the death report for (R1) which notes that resident ate his lunch and then went outside and suddenly stopped breathing. The administrator stated that there was no indication or sign that (R1) was not feeling well and about to pass in recent days. The caregiver, who was present when (R1) passed, stated she helped (R1) get in the chair where he collapsed outside. The caregiver immediately called the administrator to inform of what happened. The administrator agreed to request a copy of the county death certificate from (R1's) family member and provide a copy to the Department upon receipt in the next few weeks. There are no deficiencies cited in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Nov 28, 2023