Cromwell Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPA met with staff Zhamila Anarkulova. Administrator Renata Guzauskiene notified over the phone. LPA explained the reason for the visit. The facility is licensed for residents age range 60 and over. Approved for 6 non-ambulatory residents. The facility is a single story structure located in a residential neighborhood. It consists of the following: (4) resident bedrooms, (2) residents bathrooms, kitchen, dining room/ living room, laundry area, attached garage which used as a staff room. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. LPA toured the facility. All indoor and outdoor passageways were free of obstruction. The kitchen was inspected. LPA observed all kitchen equipment to be clean and in working condition. LPA observed sufficient supply of perishable and non-perishable foods. Large scissor, knives/sharps observed unlock in kitchen drawers. Smoke / Carbon monoxide detectors were in compliance and operational. There is (1) fire extinguisher located in the kitchen is fully charged. The common areas are clean and were properly furnished. Resident rooms were sanitary and had the required furniture and furnishings. Medications are centrally stored in a locked cabinet in the kitchen. The resident bathrooms are clean and operational w/grab bars and non-skid surface/mats in place. The hot water temperature was tested in the residents’ bathrooms and measured at 125.2°F and 126.1°F, which were not within the required range of 105°F to 120°F. Laundry detergent and cleaning solutions in the laundry area were observed unlocked. Continue 809 During today’s visit, LPA observed that the garage was being used as a staff room. Access to the garage required entering through the resident bedroom. LPA also observed that a bathroom used by staff was accessed through the resident bedroom. Staff personal belongings were observed in the garage area and in the bathroom. The residents bedrooms was being used as a passageway to access areas used by staff, which did not ensure the resident’s privacy and personal accommodations. LPA reviewed four resident files and three staff files. LPA confirmed that staff working at the facility had fingerprint clearances. During the review of resident records, LPA observed that R1’s and R2’s Physician’s Reports were not updated. R1’s Physician’s Report was dated 09/21/2023, and R2’s Physician’s Report was dated 02/10/2025. LPA reviewed clients medications. Medications are documented properly and given as prescribed. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview conducted with Zhamila Anarkulova and a copy of this report and appeal right were provided.the state’s words, verbatim · CDSS document, Aug 2, 2026

Allegation investigated: . Staff are not properly trained on emergency evacuation protocols 2. Staff were unable to effectively communicate during an emergency due to a language barrier

Licensing Program Analyst (LPA) Tuesday Cabiness conducted the initial complaint visit to investigate the allegations mentioned above. LPA met with staff and the Administrator, who was informed the reason of the visit. The following information was provided during the visit. Allegation # 1: Allegation #1: Staff are not properly trained on emergency evacuation protocols. To investigate this allegation, on 08/13/2025, from 9:15 a.m. to 1:30 p.m., (LPA) conducted interviews with the Administrator, staff, residents, and a witness regarding the concern. According to information obtained, the facility’s location recently experienced an emergency evacuation situation due to nearby fires. Interviews conducted during today’s visit revealed that staff were unable to communicate any emergency evacuation procedures or protocols. This lack of knowledge represents a potential health and safety risk to residents in care. Based on the information interviews conducted, this allegation is Substantiated. Substantiated Allegation #2: Staff were unable to effectively communicate during an emergency due to a language barrier. To investigate this allegation, on 08/13/2025, from 8:30 a.m. to 1:30 p.m., (LPA) conducted interviews with the Administrator, staff, (3) out of (6) residents, and a witness regarding the concern. According to information obtained, the facility’s location recently experienced an emergency evacuation situation due to nearby fires. During this event, Licensing and other government agencies attempted to contact the facility to determine whether an evacuation was required; however, staff were unable to communicate effectively in English. Interviews conducted during today’s visit further confirmed that communication with staff was unsuccessful due to their limited English proficiency. This inability to communicate during emergencies poses a potential health and safety risk to residents in care. Based on the information interviews, the allegation is Substantiated at this time. Citations issued, appeal rights, exit interview conducted and copy of report provided to Administrator. While communication challenges were noted, there was no evidence indicating that the facility lacked coverage by a qualified designated substitute. Based on observations and interviews, this allegation is Unsubstantiated at this time. Exit interview conducted and copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Aug 13, 2025 · control 31-AS-20250811140537

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d) · Plan of correction due date: Aug 27, 2025

Personal Requirement - General: (d)All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement was not met, evidenced by, during today's interviews, facility staff were unable to communicate any emergency evacuation procedures or protocols and the Administrator did not have an emergency plan in place. This is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 13, 2025

Plan of correction: The Administrator has AGREED to properly train staff on emergency procedures and protocols. LPA also requested a current and updated emergency diaster plan, LIC610D to be submitted for POC.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d)(3) · Plan of correction due date: Aug 27, 2025

Personal Requirement - General: (d)All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of...(3) Skill and knowledge required to provide necessary resident care and supervision including the ability to communicate with residents. This requirement was not met, evidenced by, during today's visit, staff was not able to communicate effectively in English. This is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 13, 2025

Plan of correction: Administrator will teach and practice staff to use Google translator app on the cellphone. Administrator will send a statement to LPA that staff are working on using it and practicing English.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Tuesday Cabiness conducted an unannounced annual required visit. LPA was greeted by caregiver Nataliia Savostenko, who allowed LPA to enter. She was informed the reason of the visit. Administrator Renata Guzauskiene was contacted; but was not able to attend, due to being out of the country. The current census is (4). LPA conducted a tour of the physical plant at to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Common areas: Living/dining/and kitchen area observed to be clean. Kitchen: LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the for residents currently in the home. The freezer is stocked with meats and frozen foods; with an extra refrigerator located in the garage. Food pantry in kitchen stocked with can goods and boxed foods. Medications and sharps are stored in kitchen cabinets. First aid kit was inspected. Toxins are stored and locked in the laundry room; they were locked and inaccessible to residents. Bedrooms: The facility has (4) bedrooms residents; (2) shared and (2) private. Resident's rooms have appropriate lighting, furniture, bedding, and linens. There are sufficient linens observed and available. Bathrooms: There are (2); all were clean, with soap and towels. Hot water was checked at 107.2 degrees. Surrounding Grounds: There were no visible hazards; passageways were free from obstruction and gates were easily accessible to open. Fire extinguisher fully charged. First aid kit furnished fully equipped. Smoke alarms and carbon monoxide detectors are functioning. Record review: A complete record review of staff and residents were conducted. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, Apr 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Tuesday Cabiness conducted an unannounced annual required visit. LPA was greeted by caregiver Nataliia Savostenko, who allowed LPA to enter. She was informed the reason of the visit. Administrator Renata Guzauskiene was contacted and arrived later during the visit. The current census is (5). Licensing postings and COVID signs visibly posted. LPA conducted a tour of the physical plant at to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Common areas: Living/dining/and kitchen area observed to be clean. Kitchen: LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the for () clients currently residing in the home. The freezer is stocked with meats and frozen foods; with an extra refrigerator located in the garage. Food pantry in kitchen stocked with can goods and boxed foods. Client medications and sharps are stored in kitchen cabinets. First aid kit was inspected. Toxins are stored and locked in the laundry room; they were locked and inaccessible to residents. Bedrooms: The facility has (4) bedrooms residents; (2) shared and (2) private. Resident's rooms have appropriate lighting, furniture, bedding, and linens. There are sufficient linens observed and available. Bathrooms: There are (2); all were clean, with soap and towels. Hot water was checked at 108.8 degrees. Surrounding Grounds: There were no visible hazards; passageways were free from obstruction and gates were easily accessible to open. Fire extinguisher fully charged. First aid kit furnished fully equipped. Smoke alarms and carbon monoxide detectors are functioning. Record review: A complete record review of staff and clients were conducted. There were no medication errors. All staff are vaccinated; including the (3) residents. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, May 13, 2024