Routine inspection (multi-day)·May 14, 2025

Licensing Program Analyst (LPA) Rankin arrived at 10:00 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 7 bedrooms and 5 bathrooms. The facility is occupying 2 residents. The facility locations designated for residents are clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has dual smoke and carbon monoxide detectors. Detectors were tested and working properly during visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The showers have non-skid mats/non-skid flooring. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. Disinfectant, cleaning solutions and poisons are in locked shed outside and in locked garage. 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 06/23/2025. The facility is approved for a capacity of 3 non-ambulatory and approved for hospice waiver of 2. Staffing/Personnel Records & Training: The facility employes 2 fulltime 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. Staff records are kept confidential. LPA reviewed 5 staff files. Files reviewed had current First Aid, 3 staff had current CPR cards, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions, and all required documents were present at this visit. Administrator Certificate expires on 04/12/26. LPA reviewed 5 staff training records for Annual Training Requirements of 20 plus hours. Training records for staff will be completed and provided to LPA. Disaster Preparedness : The emergency disaster forms were posted. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were inaccessible to residents in care in the immediate areas of use. The facility does not have delayed egress. The facility does not currently have residents with oxygen. The backyard is completely fenced. Exit interview conducted and copy of report printed for Administrator.