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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801684
Report Date: 10/20/2020
Date Signed: 10/20/2020 02:28:56 PM



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
08/26/2020 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20200826150339
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: 32DATE:
10/20/2020
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Charito Santos (Administrator)TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility infested with bed bugs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra made contact this date, by phone, with Administrator, Charito Santos, for the purpose of delivering findings of the above allegation. It is being conducted via phone due to COVID - 19 precautions.
It is alleged that facility infested with bed bugs. During the investigation LPA reviewed records, made observations at the facility and conducted interviews. Based on interviews conducted on 8/27/20 with Administrator and resident (R1), it was confirmed that facility failed to provide a safe and healthful environment for residents in care. Administrator provided a service agreement between AA Best Care and Hydrex Pest Control Company (License #PR639) dated 8/28/20. Bed Bugs treatment subscription is for a single service application for bed bug treatment to be done in Wing A of the facility on September 2, 2020. Wing B will be treated on September 4, 2020. Administrator provided doctor’s prescription order dated 8/26/20 for R1’s treatment including prescribed cream medication triamcinolone 0.1% to be applied to affected skin. Community Care Licensing (CCL) did not receive incident report(s) reporting the above incident with R1. The preponderance of evidence standard has been met, therefore the above allegation of Facility infested with bed bugs is found to be SUBSTANTIATED. Health and Safety Code is being cited on the attached LIC 9099D. Appeal Rights Given.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 21-AS-20200826150339
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: AA BEST CARE HOMES
FACILITY NUMBER: 496801684
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/21/2020
Section Cited
CCR
87307(d)(2)
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87307 Personal Accommodations and Services. (d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement has not been met based on evidence by:
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Administrator provided proof of service agreement between the facility and Hydrex Pest Control company. Administrator agrees to continue monthly monitoring of bed bugs and agrees to ensure that facility will receive treatment in accordance with the pest control company. Deficiency cleared at the time of inspection.
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Based on evidence by LPA's records review and interviews conducted with Administrator confirmed that the pest control company has verified that bed bugs are present in facility and continuous treatment has not been conducted which poses an immediate risk to the health and safety of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
LIC9099 (FAS) - (06/04)
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