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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803775
Report Date: 08/04/2021
Date Signed: 08/23/2021 02:07:45 PM

Document Has Been Signed on 08/23/2021 02:07 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
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ISABELLA'S HOMEFACILITY NUMBER:
486803775
ADMINISTRATOR:CRUZ-ASTORGA, SELENEFACILITY TYPE:
737
ADDRESS:915 GOLD COAST CTTELEPHONE:
(707) 759-3784
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 4DATE:
08/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Selene Cruz-AstrogaTIME COMPLETED:
11:10 AM
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Licensing Program Analysts (LPA) Karina Canela arrived unannounced to conduct an Annual Required inspection and met with Selene Cruz-Astroga, Licensee and Administrator. The annual inspection is focused on the Infection Control procedures and practices of this Enhanced Behavioral Supports Home - Adult Residential Facility.

LPA conducted a walk-through of the facility with Licensee and observed COVID-19 precaution postings. LPA observed a screening station at the garage entrance of facility which had a hand-washing station, a thermometer, and a sign-in sheet for visitors and staff. Visitors and staff are screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. Client's temperatures are taken twice a day and is documented. Staff clean and disinfect the facility twice daily. High touched surface areas are disinfected after each use. The facility has a designated visitation area, provides virtual visits and phone calls for family/visitors to stay in contact with clients.
LPA observed 4 clients in care. Staff have completed training on infection prevention, symptoms, transmission and PPE use. N-95 respirator Fit testing (Cal/OSHA requirement) is in process. The facility has a supply of PPE including gloves, face shields/goggles, N-95 respirators, surgical masks and disposable gowns.
Isabella's Home has submitted a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 which was reviewed by the California Department of Social Services.

Exit interview conducted with Licensee, whose *signature on this document confirms receipt.

Due to technical issues, a copy of this report was emailed to Licensee.
No deficiencies cited during this inspection
*Signature in file
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2021
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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