Facility Evaluation Report

On 9/9/25 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Administrator, Dale Martinez, Licensee, Lupe Martinez and Program Manager, Amanda Avendano explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility inside and out.. There are currently 6 residents residing in the facility all attending day program during time of visit.

Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced on 07/22/2025. Last fire drill on conducted on 8/17/25. Resident rooms observed to have the required furnishings and with adequate lighting. Sharps, chemicals and medications were located in locked areas. No deficiencies cited during todays visit.

LPA requested the following documents to be submitted to CCL by 9/19/2025: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

Exit interview was conducted with Administrator, Dale, Licensee, Lupe and Program Manager, Amanda. A copy of this report and TVs were discussed and provided.