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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801684
Report Date: 06/28/2023
Date Signed: 06/28/2023 03:25:26 PM


Document Has Been Signed on 06/28/2023 03:25 PM - 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: DATE:
06/28/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Licensee Angelita Aquino and Administrator, Nicanor AquinoTIME COMPLETED:
03:30 PM
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An informal meeting was conducted today in the Santa Rosa Regional Office. Present in the meeting were Licensing Program Manager Bethany Moellers, Licensing Program Analysts Marisol Cuadra, Victoria Bertozzi and representatives of the facility, Licensee Angelita Aquino, Administrator Nicanor Aquino and Administrative Assistant, Charito Santos.

The purpose of the informal conference is to address concerns regarding Administrator Certification for this facility and the Licensee's other facility, Mc Hugh Care Home 490108000 in which Tiffany Dizon is the identified Administrator.

Per discussion, Licensee has submitted training documents to the Administrator Certification Unit to renew their Administrator Certificate. Nicanor is currently working on training hours and once complete, will submit their renewal application. Licensee agrees to submit training documents along with a written plan that includes who will oversee the facilities while the certification is pending by 6/28/2023. Once plan is received, citation issued under Licensee's other facility during 5/09/2023 Annual Inspection will be cleared.

LPA will follow up with the Administrator Certification Unit to determine pending status.

No deficiencies cited during today's meeting.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023
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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