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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803775
Report Date: 02/25/2025
Date Signed: 02/25/2025 11:58:04 AM

Document Has Been Signed on 02/25/2025 11:58 AM - 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/
DIRECTOR:
SELENE CRUZ-ASTORGAFACILITY TYPE:
737
ADDRESS:915 GOLD COAST CTTELEPHONE:
(707) 759-3784
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 4DATE:
02/25/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Selene Cruz-Astorga, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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At approximately 11:15 am Licensing Program Analysts (LPAs) Elias Magdaleno and Julie Florio conducted an unannounced case management-other visit at Isabella's Home in regards to a follow-up request from Department of Developmental Services (DDS). LPAs met with Administrator Selene Cruz-Astorga to discuss areas of concern found by DDS during their semi-annual review on 10/2/24. The four (4) areas of concern followed-up during todays visit are as follows:
  • A single dose of medication was not signed off as being provided by staff on PM shift of 10/1/24, however, the corresponding bubble pack was popped and the medication was gone leading to the assumption that the medication was provided and staff failed to initial the MAR.
  • Primary Administrators ARF certificate had expired, however, CCL website confirms renewal application was submitted 5/15/24 and is waiting approval.
  • Prospective assistant administrator had served as primary administrator while the current administrator was on maternity leave. However, following the reinstatement of the current administrator, DDS has not received a formal approval request to authorize the prospective assistant administrator as such.
  • Review of randomly selected Individual Behavior Supports Plan found inconsistency in definition of a replacement behavior. The replacement behavior is intended to teach residents how to avoid unwanted conversations with staff, however, the plan defines this as requesting staff attention, the opposite of the intended goal.

LPAs discussion with Administrator documented on LIC812

LPAs found all areas of concern in compliance with title 22 regulations during today's visit.

No deficiencies cited during today's visit. Exit interview conducted with Administrator whose signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
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.

LIC809 (FAS) - (06/04)
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