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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801684
Report Date: 09/15/2022
Date Signed: 09/15/2022 09:41:08 AM


Document Has Been Signed on 09/15/2022 09:41 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: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: 31DATE:
09/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Charito Santos (Administrator)TIME COMPLETED:
09:56 AM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced for the purpose of conducting a case management and met with facility Administrator, Charito Santos.

LPA is following up on a self-incident report and SOC 341 filed by the facility Administrator to CCL on 9/7/22. The incident is involving resident (R1) aggression towards another resident (R2) in care at the facility. On 9/5/22 around 7:30am staff heard some arguments outside the office window, they went outside and observed both residents arguing with each other then R1 grabbed R2's walker and shook it making R2 to fell to the ground, R1 threw the walker away from R2. Staff was going to contact 911, but resident R2 stopped them, R2 said that they were fine. Licensee spoke to R1 who said that resident didn't do anything wrong, case workers were notified.

Upon receiving the incident report and SOC341 LPA had a discussion with the Administrator following the incident of 9/5/22 and Administrator informed LPA that case workers were notified and they hold a meeting last week were R1 apologized to R2 for the incident. R2 was seen by their primary doctor next day after the incident and no new medications changes.

During today's visit, LPA reviewed documents and determined that the Administrator has taken appropriate measures to address the aggressive behaviors exhibited by the resident.

No citations issued at this visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
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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