306001334-8-16-2024-22-AS-ARJR-D87UFY-20240816153331

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306001334
Report Date: 08/16/2024
Date Signed: 08/16/2024 03:33:36 PM

Document Has Been Signed on 08/16/2024 03:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	MARTINEZ FAMILY HOME		FACILITY NUMBER:	306001334
ADMINISTRATOR/ DIRECTOR:	SAUL IVAN MARTINEZ JR.		FACILITY TYPE:	735
ADDRESS:	1222 S ARAPAHO DR		TELEPHONE:	(714) 641-8908
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY: 4		CENSUS: 3	DATE:	08/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:01 PM
MET WITH:	Saul Martinez-Administrator		TIME VISIT/ INSPECTION COMPLETED:	03:50 PM

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Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Samer Haddadin conducted an unannounced visit for the Required 1 Year Inspection. LPAs explained the purpose of today’s visit, and were greeted and granted entry by Administrator (AD) Saul Martinez.

For today’s visit, LPA observed a total of two clients in care and two staff members on duty.

LPA observed the Administrator's Certificate for facility AD Saul Martinez which expires on March 23, 2026.

LPAs toured the interior and exterior portions of the facility with AD Martinez. The facility is a two-story home and is licensed for four ambulatory clients. There are a total of five bedrooms of which two are for clients and three for staff. LPAs toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. LPAs observed all windows were screened. Smoke and carbon monoxide detectors were tested and operational. There are a total of three restrooms of which two are for clients and one for staff. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 115.5-118.5 degrees Fahrenheit.

LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Fire extinguisher was observed to be fully charged and mounted by the kitchen. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable.

CONTINUED ON LIC809-C..

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MARTINEZ FAMILY HOME	FACILITY NUMBER: 306001334
	VISIT DATE: 08/16/2024

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LPAs observed the emergency disaster and evacuation plan, which is located by clients' bedroom hallway. Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to clients in care.

For the exterior portion, LPAs observed a shaded area, patio furniture, and the grounds were free of any hazards. There are two gates in the backyard which both are self-closing and self-latching. No bodies of water were observed.

LPAs reviewed three of three client files and three staff files. LPAs also reviewed client money and ledger for two clients. LPA Ramirez interviewed clients and staff.

During today's visit LPA observed clients' relaxing in their bedroom.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with AD Martinez.

A copy of this report was provided at the time of exit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

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