Hillside Garden RCFE

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted by, identified themselves to and discussed the purpose of the visit with Administrator Marko Kolomijcev. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. Hospice is approved for six (6) residents. During today’s inspection there were six (6) residents in care. LPA with Administrator toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. The facility was clean, sanitary, and in good repair. Resident bedrooms contained the required furnishings. Doors, windows, screens, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. 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 facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jun 24, 2026

Allegation investigated: Resident developed stage 4 pressure injury due to staff neglect

Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Licensee Jasna Popovich. On 09/30/2025, it was alleged "Resident developed stage 4 pressure injury due to staff neglect." The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review. Regarding the allegation, "Resident developed stage 4 pressure injury due to staff neglect.", it was alleged that Resident 1 (R1) had developed a stage 4 wound, staff had knowledge of the wound, and staff did not seek appropriate medical attention and wound care. (Continued on LIC9099, Page 2) Unsubstantiated (Continued from IC9099, Page 1) Staff interviews revealed when R1 was originally admitted to the facility, they arrived with a rash and blisters. Staff confirmed that the rash eventually cleared up after a couple weeks with proper bathing and an unknown cream Contact 10 (C10) applied to R1's rash. According to staff, R1 was never evaluated by a medical expert for their skin conditions and staff admitted they treated R1’s blisters under the direction of C10 or on their own. One of the staff members said staff would gently put pressure on the blister to pop them and drain the fluid, so they would not get bigger. Staff stated that approximately one year ago, a larger blister developed in between R1’s buttock cheeks (coccyx). During conversations with Contact 1 (C1) and Contact 3 (C3), C3 stated they were concerned about the blister and asked C10 several times to have R1 evaluated by hospice or home health to get care for the blister. Facility staff made all responsible parties aware that staff were not qualified to care for the blister. None of the staff have any official training treating pressure injuries and the blister on R1’s coccyx was never evaluated by a medical expert. Records review revealed that On 8/31/2025, R1 was transported to the hospital to be evaluated for a possible UTI. Medical records indicated R1’s coccyx wound was first observed on 9/2/2025, sometime after 9:00 PM when R1 was given a bed bath. However, there is no documentation the wound was staged at that time. The wound was evaluated by a wound care specialist nurse the following morning 9/3/2025, at 7:30 AM and diagnosed as a stage three pressure injury. Outside Source interviews revealed that Contact 15 (C15) and Contact 6 (C6) agreed that R1’s coccyx pressure injury could have developed from what the Facility staff member observed on the morning of 8/31/2025 when changing R1’s diaper to a stage three pressure injury on 9/3/2025, at 7:30 AM, if it went unnoticed and untreated. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Licensee Jasna Popovich, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jan 23, 2026 · control 08-AS-20250930153300

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Marko Kolomijcev. During today's visit, LPA reviewed facility records, and observed residents in care. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. No deficiencies were cited on today's date. An exit interview was conducted with Administrator Marko Kolomijcev, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jul 31, 2025

Allegation investigated: -Licensee’s staff neglected resident's needs at night. -Licensee’s staff did not treat resident with dignity.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Ernesto Aldana. LPA then met with Managers David Swagerty and Marko Kolomijcev, who arrived later during the visit. The Complainant alleged that Licensee’s staff neglected Person #1’s (P1) care needs at night, and the Licensee’s staff did not treat P1 with dignity. CCLD’s investigation involved an unannounced facility tour/welfare check and a collateral visit. LPA also reviewed pertinent records and interviewed relevant residents, staff, and outside sources. [CONTINUED ON LIC 9099] Unsubstantiated [CONTINUED FROM LIC 9099] Interviews of P1 and facility staff, corroborated by administrative records, unanimously showed: P1 was not a resident of the RCFE, either during the complaint period or currently. Rather, P1 was a tenant of an Independent Living Facility (ILF) which is attached to the RCFE premises, but which is not part of the Hillside Garden RCFE which is licensed by CCLD. During today’s visit, LPA also visited each of the six (6) residents in care at the RCFE, interviewing all those who were capable of being interviewed. LPA also interviewed multiple managers and multiple direct care staff of the RCFE. Based on records and interviews, a preponderance of evidence does not exist to show that Licensee’s staff neglected resident needs at night, or that Licensee’s staff did not treat residents with dignity. Both allegations are therefore Unsubstantiated, and no deficiencies were cited for them. An exit interview was conducted with Swagerty. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to the Licensee during today’s visit.the state’s words, verbatim · CDSS document, Dec 23, 2024 · control 08-AS-20241220085937

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Vera Sivcev. Administrator Marko Kolomijcev and David Swagerty arrived shortly after. According to the facility’s license, the facility has a maximum capacity of 6 residents, all of whom may be non-ambulatory. The facility serves residents age 60 and over. Hospice is approved for 6 residents. During today’s inspection, there were a total of 6 residents in care. This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by Marko, 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. Resident bedrooms contained the required furnishings. Doors, windows and 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 resident activities. The facility’s ambient internal temperature was 74 F. Hot water temperature at taps accessible to residents were all compliant: Bathroom #1 sink was 107.8 F, Bathroom #2 sink was 107 F and Bathroom #4 sink was 119.4 F. Bathroom #3 was non-operable at this time. 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, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. (continued on next page, LIC 809-C) No pools or bodies of water were observed on the premises. Per Marko Kolomijcev 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(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed multiple staff and residents. LPA reviewed multiple staff and resident records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Marko, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Apr 24, 2024