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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701321
Report Date: 02/14/2024
Date Signed: 02/14/2024 01:13:31 PM


Document Has Been Signed on 02/14/2024 01:13 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ST. MARTIN'S CARE HOMEFACILITY NUMBER:
342701321
ADMINISTRATOR:RODIL, MARTINFACILITY TYPE:
740
ADDRESS:10720 BECLAN DRIVETELEPHONE:
(916) 934-9327
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:6CENSUS: 0DATE:
02/14/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Marty RodilTIME COMPLETED:
01:30 PM
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On 02/14/2024, Licensing Program Analyst (LPA) Kimberly Viarella made an announced visit to this facility to conduct a Pre-Licensing inspection. LPA identified herself upon arrival, stated the purpose of the visit and met with Martin (Marty) Rodil, the Licensee and Designated Facility Administrator (DFA).

The DFA and the LPA toured the interior and exterior of the facility. The Plan of Operation, future resident and staff files were reviewed as well as medication storage and administration. All the resident rooms were in compliance with regard to the lighting, furniture, and furnishings. Both bathrooms contained grab bars and handrails. DFA to install a paper towel dispenser. Kitchen, living, and dining rooms were in compliance. Laundry facilities were in the garage as was additional holiday storage. A locked cabinet for medications was located in the kitchen.

This facility did not pass its pre-licensing inspection due to the following:
- 3 ramps will be removed as they were not ADA compliant, and also posed a safety risk to ambulatory residents due to the steep slope and lack of handrails.
- Fence needed to be repaired as it was missing posts.
- Debris removed from back yard.
- 4 bedroom window screens needed to be replaced
- Kitchen needed a deep cleaning and more kitchen supplies (silverware, pots and pans)
- DFA was missing TB test results
- First Aid kit was missing its thermometer

The DFA has agreed to have the above corrected by 02/23/24 and this LPA will return to complete this Pre-Licensing Inspection and COMP III.
A copy of this report was provided to the DFA.
Exit Interview.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024
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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