Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 8:57 am to complete the 1-year annual visit to the facility above. LPA met with Robert Martinez, Licensee and explained the purpose of the visit.

The following was inspected and noted during the annual continuation visit:

Physical Plant & Environment Safety: The facility has 8 bedrooms and 5 bathrooms. The facility is occupying 1 resident. The facility locations designated for residents are clean, safe and sanitary. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture and shade. The facility has telephone and internet service for resident use. The backyard has 5 sheds, sheds that include chemical and/or tools will be locked.

Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance based on the facility sketch. The facility has current liability insurance and expires on 06/23/2026. The facility is approved for a capacity of 3 non-ambulatory and approved for hospice waiver of 2. Fire extinguisher was charged and reviewed on 6/24/25.

Staffing/Personnel Records & Training: The facility employes 2 full-time staff and 1 Administrator, there are also 2 back-up staff and 2 live in adult family members who are not staff, but they are approved on the Guardian list. LPA reviewed 4 staff files. Files reviewed had all required documents including current 1 st Aid certification, all but one staff have CPR training. Administrator Certificate expires on 04/12/28. LPA discussed staff training records for Annual Training Requirements of 20 plus hours. Training records for staff will be completed and provided to LPA.