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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803775
Report Date: 02/25/2025
Date Signed: 02/25/2025 12:00:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2024 and conducted by Evaluator Julie Florio
COMPLAINT CONTROL NUMBER: 21-AS-20241115090513
FACILITY NAME:ISABELLA'S HOMEFACILITY NUMBER:
486803775
ADMINISTRATOR:SELENE CRUZ-ASTORGAFACILITY TYPE:
737
ADDRESS:915 GOLD COAST CTTELEPHONE:
(707) 759-3784
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:4CENSUS: 4DATE:
02/25/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Selene Cruz-Astorga, LicenseeTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility staff do not ensure that resident is provided with basic laundry services.
INVESTIGATION FINDINGS:
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On 02/25/2025, at approximately 10:15 AM, Licensing Program Analysts (LPAs) Julie Florio and Elias Magdaleno arrived unannounced to deliver findings for the above allegation. Reporting Party (RP) alleges that Facility did not ensure clients were provided basic laundry service when the facility’s washer machine broke down.

LPA Florio conducted 10-day investigation visit on 11/18/2024 and made observations, conducted interviews, and obtained documents. LPA interviewed the Administrator and Assistant Administrator/Staff 1 (S1), which revealed the facility’s washer machine had been acting up since at least the beginning of 09/2024 and that staff took the clients’ laundry to a laundry mat during such time the facility was going round and round with the manufactuer, the store it was purchased from, and their contracted repair company to get the washer machine fixed. The washer machine was fixed in 10/2024. Most recently, in 11/2024, the machine broke down and staff did not inform the Administrator until two days later.

Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 21-AS-20241115090513
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: ISABELLA'S HOME
FACILITY NUMBER: 486803775
VISIT DATE: 02/25/2025
NARRATIVE
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Continued from LIC9099...

LPA received receipt documentation which confirmed that facility paid for laundry services out of facility's petty cash when the washer machine was out of service. However, LPA observed staff arriving to the facility with clients' laundry from the laundry mat during 11/18/2024 visit.

Based on interviews conducted, observations made, and record review, the allegation listed above is SUBSTANTIATED. A finding that a complaint allegation is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiency is cited from Title 22 Regulations, Division 6, (see LIC9099D).

Exit interview conducted. Copy of report discussed and provided to Licensee, whose signature on form confirms receipt of documents. Appeal rights provided.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20241115090513
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: ISABELLA'S HOME
FACILITY NUMBER: 486803775
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2025
Section Cited
CCR
85088(d)
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85088 Fixtures, Furniture, Equipment and Supplies (d) If the facility operates its own laundry, necessary supplies shall be available and equipment shall be maintained in good repair.
This requirement is not met as evidenced by:
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Licensee provided receipt proof of purchase for a new washer machine and phot proof that a new washer machine has been installed in the facility on 11/18/2024. POC cleared during today's visit.
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Based on observation, record review, and interviews, Licensee did not ensure the facility's washer machine was maintained in good repair. This poses a potential Health, Safety or Personal rights risk to clients 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.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3