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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803882
Report Date: 08/26/2020
Date Signed: 08/27/2020 11:54:32 AM

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:CASA ISABELLA IIFACILITY NUMBER:
486803882
ADMINISTRATOR:VILLEGAS, ART GFACILITY TYPE:
740
ADDRESS:680 SNAPDRAGON PLTELEPHONE:
(707) 344-0839
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY:6CENSUS: 4DATE:
08/26/2020
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
05:37 PM
MET WITH:Art VillegasTIME COMPLETED:
07:08 PM
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Licensing Program Analyst A. Canela conducted this Post Licensing inspection via video conferencing due to Covid 19 precautions with Administrator/Licensee, Art Villegas. This home is licensed for 6 residents, of which 3 may be on Hospice services.

The Facility is a 4-bedroom, 2-bathroom, single story house. Administrator conducted a walk through of the home via video conferencing and LPA observed, that resident rooms had the required furnishings. The home was observed clean and well organized. Exit doors have working alert devices. Bathrooms were equipped with non-slip mats for safety and the bathrooms were observed with proper hand washing and sanitation precaution posters for Covid-19. In addition, LPA observed facility required postings (LTCO, CCL Complaint poster, Personal Rights) and COVID-19 required visitation postings. Facility has a sanitation station set up at the entrance of the facility in order to comply with Covid-19 precautions. Facility is screening staff or essential visitors for symptoms. Facility staff were observed wearing mask during the virtual tour of main entrance, doors, common areas, dining rooms and kitchen area. The facility assists residents so that they can communicate with their family via telephone or video call. Facility has at least two days of perishable and one week of nonperishable foods, and an extra freezer with food in the garage. Facility has space indoors and outdoors for resident activities.
Fire extinguisher was charged and mounted on wall. Carbon Monoxide Detector and smoke detectors were operational. Toxins are observed locked and inaccessible to residents in care. Medications and knives were observed locked.
Resident and staff records are maintained. LPA was unable to conduct a thorough review of records but did confirm that staff active First Aid/CPR Certificate. Medication is centrally stored and locked. A Centrally Stored Medication Log is maintained. LPA discussed facility's Disaster Preparedness with Licensee including observing their Emergency supplies.

No deficiencies cited during this tele-visit inspection.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020
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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