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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801684
Report Date: 07/15/2020
Date Signed: 07/15/2020 08:42:19 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/15/2020 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20200415151445
FACILITY NAME:AA BEST CARE HOMESFACILITY NUMBER:
496801684
ADMINISTRATOR:AQUINO, NICANORFACILITY TYPE:
740
ADDRESS:857 HEARN AVE.TELEPHONE:
(707) 546-8413
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:40CENSUS: DATE:
07/15/2020
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:TIME COMPLETED:
09:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident not provided assistance with basic care needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Leibert made contact with Administrator Charito Santos for the purpose of delivering findings on the above - captioned complaint. The visit was conducted via tele-visit due to COVID - 19 precautions. The complaint suggests that R1 was not provided assistance with basic care needs in that it is alleged that R1 was observed by medical personnel to have feces on pants and on fingers suggesting staff neglect. This Department has investigated the allegation by interviewing witnesses and reviewing and obtaining records. The following determinations have been made: R1 was admitted to a medical facility on or about 4/8/20; Complainant and witness (W1) report having heard from unnamed sources that when R1 was admitted R1 was observed to have been neglected in R1's hygiene; Neither reporter had any first hand observations of R1 and were not able to provide names or other means of identification of those who may have observed the alleged neglect; The medical records obtained from the medical facility are silent on the issue and make no mention of R1's hygiene or related comments that might support the allegation. Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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