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Facility Evaluation Report

Southland Home, Nipomo05/12/2026Licence 405802555

Capacity4
Census4
Date signed05/12/2026 05:23:10 PM
Name of licensing program analystMelisa Rankin
Name of licensing program managerKelly Burley
The inspector’s account

Licensing Program Analyst (LPA) Rankin arrived at 10:56 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Ana Martinez, Administrator and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit:

Physical Plant & Environment Safety: The fire extinguishers were last charged and inspected on 07/14/2025. The facility is a four (4) bedroom and three (3) bathroom facility currently occupying four (4) residents. There are two (2) additional restrooms inaccessible to residents and for staff only. The facility has hard wired, dual smoke and carbon monoxide detectors that were tested. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid flooring. The pathways are clear of any obstructions.

Disinfectant, cleaning solutions are inaccessible to residents in care locked and stored in the laundry room and or locked under kitchen sink. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade.

Operational Requirements: The facility has current liability insurance. The facility has a current plan of operation on file with the department. The facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of four (4). Fire clearance is granted for four (4) Ambulatory of which three (3) may be non-Ambulatory and one (1) may be bedridden.

Staffing, Personnel Records & Training: The facility currently employs six (6) full-time staff, 2 part-time staff, one (1) registered nurse, one (1) Facility Manager and one (1) administrator. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, and Health screening with TB results. Administrator Certificate expires 06/11/2027. Staff have annual training for various subjects/topics for 2025 and 2026. Continued on 809-C

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction