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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803882
Report Date: 12/19/2024
Date Signed: 12/20/2024 10:38:46 AM

Document Has Been Signed on 12/20/2024 10:38 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CASA ISABELLA IIFACILITY NUMBER:
486803882
ADMINISTRATOR/
DIRECTOR:
VILLEGAS, ART GFACILITY TYPE:
740
ADDRESS:680 SNAPDRAGON PLTELEPHONE:
(707) 344-0839
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
12/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Art Villegas, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Canela arrived unannounced, to conduct an Annual Required 1 YR inspection and was greeted by two care staff. Licensee/Administrator, Art Villegas arrived a few minutes later. This home is licensed for up to 6 non-ambulatory residents with a Hospice waiver approved for 3 of the residents.

LPA toured facility and grounds and observed all required signs posted in common areas. Facility was found to be at a comfortable temperature with all exits free from obstruction. Facility has at least two days supply of perishable and one week of non-perishable foods that are stored properly. All exit doors have working auditory devices to alert staff. Smoke detectors and carbon monoxide detectors were operational. Fire drills are conducted every three months and the last drill was documented on 12/5/2024 . Fire Extinguisher was fully charged. Water temperature in the resident bathroom was tested and found to be at 109 degrees and within appropriate range of 105-120 degrees. The bedrooms are all furnished as required. Bathrooms were clean and sanitary with non-skid mats/floors and grab bars.

Resident and staff files are located and locked in office. LPA reviewed all resident files and were found to be complete and organized with current medical assessments and appraisal. Staff files were reviewed and found complete with proper fingerprint clearances, health screenings, proof of required annual training and CPR/1st Aid certificates expiring 12/2026.

Administrator certificate for Art Villegas #6052479740 expires, June 9, 2025.


Continue report See LIC809-C
Kimberley MotaTELEPHONE: (707) 588-5051
Araceli CanelaTELEPHONE: (707) 588-5041
DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CASA ISABELLA II
FACILITY NUMBER: 486803882
VISIT DATE: 12/19/2024
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Licensee/Administrator to submit all the below documents to LPA by 1/20/2025

· LIC 308 Designation of Facility Responsibility
· LIC 500 Personnel Report-
· LIC 610E Emergency Disaster Plan
· LIC 9020 Register of Facility Residents
Infection Control Plan of Operation (If changes)
Copy of Liability Insurance-
Copy of Administrator Certificate


No citations issued during todays inspection.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC809 (FAS) - (06/04)
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