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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801684
Report Date: 05/21/2024
Date Signed: 05/21/2024 02:44:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/05/2024 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240405140542
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:
05/21/2024
UNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Charito Santos (Administrative Assistant)TIME COMPLETED:
02:59 PM
ALLEGATION(S):
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-Facility is not meeting resident's care needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Administrative Assistant Charito Santos.

The Department received an allegation of facility is not meeting resident's care needs. Per Reporting party, resident (R1) was observed to be unclean, unkept with black dirty caked fingernails, dirty, dry skin with multiple open small wounds to anterior chest from bug bites, wounds to posterior back, sacrum, and bilateral heels with dried blood spots. On 4/25/24, the department received a call from an agency cross-reporting additional information regarding same allegation. Per reporting party, R1 was observed with dirt under their nails and was infested with bed bugs and mites. In addition, it was reported that another resident (R2) was observed during regular checkup on 4/19/24 with lice and it appeared that R2 had not been bathed properly.
Continue on LIC9099C...
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: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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 3
Control Number 21-AS-20240405140542
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 HOMES
FACILITY NUMBER: 496801684
VISIT DATE: 05/21/2024
NARRATIVE
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Continued from LIC9099...

On 5/1/24, the department received a second call from another agency reporting additional information regarding the same allegation. However, this incident was involving three other residents (R2, R3 and R4) who were transported to a regular checkup, but as R2 pulled up their sleeve for blood test, it was noticed bugs attached to R2’s arm with possibly under the skin, along with some long black marks. Based on LPA’s records review, on 4/6/24 the Santa Rosa Police Department have conducted a welfare visit to the facility (event # SR2400040510), where findings resulted in a case closed disposition and referral to another agency due to findings of bed bugs, lack of cleaning and maintaining logs updated. The facility provided records of internal temperature log documentation that indicates that the facility had been treating resident’s rooms in a regular basis, but R1’s room revealed that the last treatment was conducted on 10/25/23. Based on observations, LPA conducted an unannounced visit to the facility on 4/9/24. During this visit, LPA toured resident’s bedroom and observe the facility appeared to be clean, safe and in sanitary condition. Although, LPA is unable to determine if an area of the facility was clean and sanitary condition at a prior date. On 5/3/24, the facility notified the department that they have treated R2’s bedroom and confirmed that R2’s room has not been treated since September 2023. After been notified of the presence and lack of treatment of bedbugs in the facility. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given.

SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20240405140542
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 HOMES
FACILITY NUMBER: 496801684
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/22/2024
Section Cited
CCR
1569.269(a)(5)
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Type A §1569.269 Enumerated rights; severability (a) Residents of RCFE shall have all of the following rights: (5) To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement has not been met as evidence by:
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Licensee/Administrator agrees to submit a plan/schedule to ensure facility is following up on resident’s needs, observation of the resident and treating all resident's rooms timely to CCL by POC due date.
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Based on LPA record review and interviews conducted the facility did not ensure R1 was accorded safe, healthful and comfortable accommodations which resulted in R1 and R2 sustaining injuries which poses an immediate health and safety risk to 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: 05/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC9099 (FAS) - (06/04)
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