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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701321
Report Date: 03/04/2025
Date Signed: 03/04/2025 04:51:54 PM

Document Has Been Signed on 03/04/2025 04:51 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/
DIRECTOR:		RODIL, MARTINFACILITY TYPE:
740
ADDRESS:10720 BECLAN DRIVETELEPHONE:
(916) 934-9327
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 6CENSUS: 1DATE:
03/04/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Martin Rodil TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On 03/04/25, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to continue the annual inspection. LPA identified herself upon arrival, stated the purpose of the visit and met with the Licensee, Martin Rodil. LPA presented Rodil with a list of documents that Community Care Licensing required.

LPA inspected the kitchen. All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. Opened packages in the refrigerator were dated appropriately. All pantry items were dated as well.

LPA inspected all resident bedrooms. All resident rooms had the required furniture, furnishings and lighting to be in compliance at this time. One resident room was malodorous. The Licensee explained that it could be due to cats having been in that room. LPA explained that the facility must be kept clean and sanitary per California Code of Regulations (CCR) 87303(a). This deficiency was cited on the LIC 809D page.

LPA noted soap, paper towels, and trash cans with lids in the bathrooms. The tub/shower floor had a non-slip surface, as required. The hot water temperature was measured at 105.1 degrees Fahrenheit and was in compliance at the time of this inspection. The fire extinguisher was purchased on 3/4/25 from
Jorgensen Co. and the receipt was attached for LPA review.

LPA reviewed the Centrally Stored Medication and Destruction Record (CSMDR) and reviewed the storage, administration, and destruction, of resident medications. LPA provided technical assistance regarding the storage of nutritional supplements. LPA inspected the first aid kit to ensure it had all of the required elements. It was in compliance at the time of inspection.

LPA conducted a review of the resident and staff files and found that the resident's file was complete and in
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ST. MARTIN'S CARE HOME
FACILITY NUMBER: 342701321
VISIT DATE: 03/04/2025
NARRATIVE
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compliance. The staff files reviewed were missing documentation for training. This deficiency was cited on the LIC 809D page. As this facility is new, LPA provided technical assistance and answered questions regarding the orientation and annual training required.

LPA inspected the exterior of the building. The yard was completely fenced in and there were no bodies of water present. There was also a patio area with furniture for residents to enjoy. All window screens and gutters were in good repair at the time of inspection.

According to the California Code of Regulations, Title 22, deficiencies were cited on the LIC 809D page. A copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted with Martin Rodil.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
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Document Has Been Signed on 03/04/2025 04:51 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 03/04/2025 at 02:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ST. MARTIN'S CARE HOME
FACILITY NUMBER: 342701321

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/31/2025
Section Cited
CCR
87411(c)

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Personnel Requirements - General
All RCFE staff who assist residents with personal activities of daily living shall receive annual training...

The Licensee did not ensure the above requirement was met as evidenced by:
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Licensee stated he will investigate online training for all employees and have it completed by 3/31/25. Documentation will be supplied to Community Care Licensing at CCLASCPSacrementoRO@dss.ca.gov and kimberly.viarella@dss.ca.gov by 3/31/25.
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Based on file review and interview, the Licensee did not conduct or record orientation or annual training for the facility employees. Even though he hired experienced staff, training is still required. This posed (poses) a possible threat to the health, safety and personal rights of the resident in care.
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Type B
03/31/2025
Section Cited
CCR87303(a)

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 Maintenance and Operations
(a) The facility shall be clean, safe, sanitary and in good repair at all times...

The Licensee did not ensure that this regulation was met as evidenced by:
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Licensee stated he will deep clean the room including the carpet. This too will be completed by 03/31/25. Licensee will notify LPA upon completion at kimberly.viarella@dss.ca.gov so the LPA can make a plan of correction visit.
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Based on observation and interview one of the residents bedrooms was malodorous and needed to be cleaned to ensure it was sanitary after the licensee told this LPA that cats had been in there. This posed a potential risk to the health, safety, and personal rights to the resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Stephen Richardson
LICENSING EVALUATOR NAME:Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2025


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