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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801416
Report Date: 07/18/2025
Date Signed: 07/18/2025 01:19:02 PM

Document Has Been Signed on 07/18/2025 01:19 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:INFANTE FAMILY HOME, INC.FACILITY NUMBER:
486801416
ADMINISTRATOR/
DIRECTOR:		INFANTE, CECILIAFACILITY TYPE:
735
ADDRESS:1931 DIAMOND WAYTELEPHONE:
(707) 319-8744
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 6CENSUS: 4DATE:
07/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Cecilia Infante - licensee/administratorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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At approximately 9:55 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by licensee/administrator Cecilia Infante. Facility is an Adult Residential Facility with four (4) ambulatory clients in care. LPA was informed that three (3) clients left for day program; one (1) client was present during visit.

At approximately 10:15 AM, LPA initiated a tour of the facility with licensee and observed the following: Facility is a one story home, was a comfortable temperature, a front walk way could be made safer by reducing a trip hazard lip of concrete and technical advisory was issued, driveway was otherwise in excellent condition. Water temperature in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens and paper products available to clients. Clients' bedrooms were inspected and LPA observed two bedrooms with minimal lighting. Licensee states this is due to the two clients in these rooms exhibit documented destructive behaviors as noted in their IPPs. Licensee and IPP state lights were removed for the safety of these two clients. It was recommended that licensee try to deliver alternative means of increased lighting in these two bedrooms if it could be done safely; home was not built with ceiling lights. LPA observed the client bedrooms to contain all of the remaining appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and medicines and other items that could pose a risk were locked. Facility has at least two days of perishable food and a supply of non-perishable foods. Refrigerators in the garage were noted to have accumulated dust on the bottom, as well as, the seals of the doors and a technical advisory was issued to clean them to ensure on-going compliance. There is a sun room with a seating area and outdoor space for activities including games, music, and gardening. LPA observed an activity schedule and a facility computer available for client use. Facility has internet available to clients in care, and the facility phone was tested and observed to be operable. In addition facility has an generator for emergency power generation.

Continued on LIC809-C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: INFANTE FAMILY HOME, INC.
FACILITY NUMBER: 486801416
VISIT DATE: 07/18/2025
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Continued from LIC809...
Facility's fire extinguisher was observed charged and was last serviced May 2025. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts regular quarterly disaster drills, with the most recent drill conducted May 17th, 2025. LPA observed facility's infection control plan and emergency disaster plan which was last updated May 2025.

At approximately 10:45 AM, LPA reviewed five (5) staff files and four (4) client files. Four (4) of 4 staff files reviewed have the required paperwork, proof of current first aid/CPR certificate and health clearance including TB. One (1) of 5 pending staff members has not worked their first day and although criminally cleared and associated to the home will need evidence of 1st aid training and TB clearance to begin work (Licensee was advised)
Four (4) of four (4) resident files reviewed contained all of the required paperwork. Licensee coordinates medical and dental visits for the clients and takes them to their appointments.

At approximately 12:15 PM, LPA reviewed medications and medication records which are maintained in compliance with regulation. LPA reviewed P&I monies and logs, with money accurately logged and safely stored. Facility was noted to be managing an amount of P&I money over their Affidavit Regarding Client Cash Resources (LIC400), but well under their surety bonding valid through June 2027. A technical violation was issued and licensee signed an updated LIC400 for the proper amount and the new LIC400 was obtained today by this LPA.

Updated copy of appropriate LIC400 Affidavit Regarding Client Cash Resource was obtained today

Updated copies of the following documents are to be submitted to CCL by 08/18/2025:
LIC 500 facility employee roster/schedule
LIC610- Emergency Disaster Plan (updated)
LIC 308 Designation of Facility Responsibility (if any changes)
LIC200 (for changed facility use -staff room and client room change)
New updated facility sketch to match planned facility use per LIC200 (plans for a future ADU can be considered in the future)

Technical advisories and violations are cited California Code of Regulations (CCRs), and/or the Health and Safety Code.

Exit interview conducted with licensee and Appeal rights were given. Signature on form confirms receipt.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC809 (FAS) - (06/04)
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