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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801684
Report Date: 11/09/2020
Date Signed: 11/09/2020 11:01:08 AM



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
07/22/2020 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20200722160925
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: 30DATE:
11/09/2020
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Nick Aquino (Licensee)TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff are mismanaging residents medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra conducted a complaint investigation regarding the above allegations. Tele-visit with Licensee, Nick Aquino was conducted due to COVID-19 precautions on November 9, 2020 and on this date for the purpose of closing the complaint.

LPA conducted interviews, requested and obtained records. LPA received on 7/22/20 self-incident report regarding resident’s (R1) hospitalization on 7/20/20. Although, interviews conducted with Administrator revealed that resident was hospitalized on 6/25/20 and discharged on 7/10/20 and the second time was admitted to the hospital on 7/20/20 and discharged on 7/22/20. CCL did not receive any incident report regarding first hospital admission on 6/25/20 to 7/10/20. Facility provided medication records for the month of July 2020 indicating that staff assisted resident with the administration of medications on July 6, 7, 8 and 9 while resident was in the hospital.

Continues 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: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
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 4
Control Number 21-AS-20200722160925
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
VISIT DATE: 11/09/2020
NARRATIVE
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Continued from LIC9099...

Discharge documentation dated 7/10/20 provided by facility indicated that resident was scheduled for following appointment on 7/14/20. LPA obtained doctor’s order from visit on 7/14/20 to Mental Health Division, were it was alerted to the facility staff to discontinue the following medications: Ativan (Lorazepam), Propranolol, Congentin (Benztropine) and Diphenhydramine (PRN). However, medication records indicates that Lorazepam and Propranolol were administered to R1, three times a day on July 14, 15, 16, 17, 18 and 19. On 11/2/20 Administrator informed LPA during interview that the staff who assists residents with medication, initialed medication records by mistake but medication was not administered to R1. LPA will address medication training on a case management inspection.

The preponderance of evidence standard has been met, therefore the above allegation of Staff are mismanaging resident’s medication is found to be SUBSTANTIATED. Health and Safety Code is being 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: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 21-AS-20200722160925
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: 11/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2020
Section Cited
CCR
87465(c)(2)
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87465 (c)(2) Incidental Medical and Dental Care. If the resident's physician has stated in writing that resident is unable to determine his/her own need...(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement has not been met as evidence by:
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Licensee agrees to review all residents medications to ensure meds are recorded as requried. Licensee agrees to provide medication training to staff who assists residents with medication. Licensee to provide proof of training and names of staff trained to CCL by POC due date 11/27/20.
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Based on records review & interviews conducted with Administrator on 11/2/20 LPA was informed that staff who assists R1 with administration of medication initialed R1's medication records by mistake on several days while R1 was in the hospital & after medication was discontinued by Physician which poses a potential rist to the health & 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: 11/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
07/22/2020 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20200722160925

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:
11/09/2020
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Charito Santos (Administrator)TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff did not administer residents medication resulting in hospitalization
INVESTIGATION FINDINGS:
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12
13
 Licensing Program Analyst (LPA) Cuadra conducted a complaint investigation regarding the above allegations. Tele-visit with Licensee, Nick Aquino was conducted due to COVID-19 precautions on November 9, 2020 and on this date for the purpose of closing the complaint.
Based on LPA’s interviews and records review, staff who assist in the administration of medications do not have within the last year a required medication training as indicated per regulation. LPA also reviewed incident reports submitted to CCL which indicated that residents that needed medical attention received the necessary medical services. However, facility did not submit an incident report for R1's hospitalization on 6/25/20 to 7/10/20 as required by regulation. Medication records indicated discrepancies with the administration of medications during R1’s hospitalizations there is no evidence to prove that staff did not administer resident medication resulting in hospitalization.
A finding that the complaint allegation Staff did not administer resident medication resulting in hospitalization is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4