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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801684
Report Date: 02/08/2024
Date Signed: 02/08/2024 03:06:52 PM


Document Has Been Signed on 02/08/2024 03:06 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: 28DATE:
02/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Charito Santos (Administrative Assistant)TIME COMPLETED:
03:21 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced for the purpose of conducting a case management to follow up on SOC341 along with a self-incident reports and met with facility Administrative Assistant, Charito Santos.

On 2/5/24 at approximate 5:30pm staff (S1) called 911 due to a resident (R1) was making threats to shoot S1 and burn the facility. The incident started when S1 asked R1 if they could wash their beddings and R1 replied ok, then S1 noticed trash in a small bag, R1 took the trash bag, but R1 approached S1 requesting the trash bag back to them. They both went back to R1's bedroom to search for the bag when they couldn't find it, R1 told S1 the following: "I will get a gun and shoot you and will burn down this facility". The police officer arrived and file a case report #240360217. The facility notified responsible parties including CCL. During today's visit, LPA reviewed records and conducted interviews with staff. Per S1, R1 apologized to them after the incident. R1 also had an appointment to see their physician on 2/7/24 at 1pm, but the appointment was postponed until unknown date. Per Charito, the facility is in the process of issuing a 30-day eviction notice to R1 due to the threats to the facility including residents in care. The Department will review documents received.

No deficiencies during today's visit. Exit interview was conducted with Administrative Assistant and a copy of this report was given.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024
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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