Dysico Care Home, Rcfe

On 9/17/2025 at 9:45 AM, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced annual 1-year required inspection. LPA met with Administrator Evangeline Lekse and explained the purpose of the visit. The administrator currently holds a certificate (#7007428740) that expires on 03/08/2027. The facility’s fire clearance was approved for six (6) residents, six (6) may be non-ambulatory with an approved hospice waiver for two (2) residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of seven (7) total bedrooms which six (6) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. The facility consists of four (4) bathrooms, two (2) of which are shared resident bathrooms and two (2) private resident bathrooms. All indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 75 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the facilities kitchen was measured at 123.1 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. Smoke detectors and carbon monoxide combination were in operating condition during visit. Continued on LIC809C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Fire extinguisher was last purchased on 9/3/2025. First aid kit was observed to be complete. LPA reviewed six (6) staff and six (6) resident records. LPA reviewed a sample of medication. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 9/24/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 09/20/2023 at 11:41 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required Inspection. LPA met with Administrator/Caregiver, Evangeline Lekse, and explained the purpose of the visit. Evangeline's Administrator Certificate# 6024122740 Expired 03/08/2023. Evangeline is waiting for a renewal certificate to arrive. The facility’s fire clearance was approved for 6 non-ambulatory. Also the facility has a Hospice Waiver for 2 Residents. LPA toured facility with Evangeline including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ 2 shared bathrooms was measured at 109.0, 111.2/111.0 (double sink) degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. LIC809-C Continued... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LIC809 Continued... There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 09/14/2023. Emergency Disaster Plan was last posted on 07/20/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 07/20/2023. At 12:30PM, LPA reviewed 6 Residents records. At 2:30 PM, LPA reviewed 7 staff records and 6 of 7 have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 09/27/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 09/20/2023 at 4:21PM, Licensing Program Analyst (LPA), L. Alexander conducted an unannounced Case Management in regard to a phone call from Staff (S1), regarding one of the Residents. S1 called LPA L. Alexander on 09/18/2023 with concerns for R1 because they have been drinking alcohol (Vodka) and not eating. S1 had concerns that R1 may have symptoms of alcohol withdrawal and that the Staff would not be able to handle that type of issue if it occurred. S1 says that R1 was admitted earlier to their facility under hospice care and that the Physician's Report (LIC602) did not say that there was any type of alcohol/substance abuse. The hospice agency (HA) was allowing R1 to consume alcohol. R1 was discharged from hospice on 07/21/2023. The updated LIC602 dated 09/13/2023 includes to question #13 and #14: (f) Substance Abuse Problem - yes, and (g) Use of Alcohol -yes (2.5L in 24hrs). Question#14 (c) Aggressive Behavior - yes (when intoxicated). S1 was concerned for compliance as well that R1 may be harming herself because she isn't eating much. There is a doctor's order with restrictions for R1, "R1 should not drink any alcohol." 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA spoke with R1 during "Client Interview" while conducting an Annual Inspection today. R1 says that she doesn't really go out in the main common area. R1 says that she doesn't eat much because she just doesn't eat. However, R1 says that she orders her own snacks (chips, salsa, water, seltzer drinks, etc) through Instacart and that's how she receives her delivered items. R1 has a instant ice maker and Keurig coffee maker in her private room. Today, R1 says that she ate a hotdog today for lunch but probably won't eat anything else. LPA requested and received documents for R1: Physician's Report LIC602; dated 06/05/2023 Physician's Report LIC602; dated 09/15/2023 Kaiser's Activity Status Report; dated 09/13/2023 (doctor's order with restrictions no alcohol) No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.

Licensing Program Analyst (LPA) James Sampair conducted an unannounced pre-licensing inspection and met with Administrator, Evangeline Lekse. LPA explained the reason for the visit. LPA observed 2 of the 2 staff wearing masks. LPA also observed 4 residents resting in their bedrooms during the visit. In this follow up of the initial 10/07/21 pre-licensing visit, the LPA again toured the facility inside and outside, including but not limited to resident's bedrooms, bathrooms, dining room, common living areas, kitchen, and outside patios. No reduction in the standard of care nor in the cleanliness and orderliness of the physical plant has occurred. The LPA also saw proof that the Applicant, Josephine Dysico, has completed all of the necessary changes identified on 10/07/21: adequate emergency lighting in easily accessible locations, updates to the Emergency and Disaster Plan, and an LIC 999 Facility Sketch of the Yard with a Resident Assembly Point on it. With those changes in place at the facility, this report is ready to be submitted to the central application unit (CAU), where a final review of the application will be conducted: This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.