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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803775
Report Date: 10/10/2023
Date Signed: 10/10/2023 05:13:08 PM

Document Has Been Signed on 10/10/2023 05:13 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ISABELLA'S HOMEFACILITY NUMBER:
486803775
ADMINISTRATOR:ANGELICA B. GONZALODOFACILITY TYPE:
737
ADDRESS:915 GOLD COAST CTTELEPHONE:
(707) 759-3784
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 4DATE:
10/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Jennifer Kearns, CaregiverTIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA), Carol Fowler conducted an unannounced Case Management-Other inspection at Isabella's Home. LPA was greeted at the door by Jennifer Kearns, Caregiver, and was granted access into the facility. The purpose of this Case Management-Other inspection is to follow up on findings and recommendations from DDS Semi-Annual Review visit that was conducted on 10/5/2023. Administrator Angelica Gonzalodo arrived at approximately 4:35pm.

During the Case Management-Other inspection, LPA and Administrator toured facility and conducted a record review. During tour LPA confirmed closet storing hand sanitizer, has not been replaced but sanitizer was moved into locked office. Disinfectant wipes and meat thermometer are locked and inaccessible to clients. During record review LPA confirmed that Administrator has documented staff training hours. Administrator created and will submit restraint logs and resubmit documents today 10/10/2023.

No deficiencies were observed or cited during today's Case Management-Other inspection. Exit interview was conducted and a copy of this report was provided to the Administrator
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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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