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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801684
Report Date: 08/29/2024
Date Signed: 08/29/2024 01:51:34 PM


Document Has Been Signed on 08/29/2024 01:51 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: 25DATE:
08/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Charito Santos (Administrative Assistant)TIME COMPLETED:
02:06 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced for the purpose of conducting a case management to follow up on Administrator certificate and met with Charito Santos, Administrative Assistant.

On 6/28/23 an informal meeting was conducted in the Santa Rosa Regional Office to address concerns regarding Administrator certification at this facility and the Licensee's other facility, Mc Hugh Care Home 490108000 in which Tiffany Dizon is the identified Administrator. During annual inspection on 7/23/24, LPA issued a citation to the facility due to not having supporting evidence that submitted required documentation was received by the Department's certification unit and Licensee agreed to re-submit it timely. On 7/25/24, the facility submitted certified mail tracking # 9589 - 0710 - 5270 - 2020 - 4761-14 dated 7/25/24 with Sacramento's address on it to CCL to clear the citation. However, On 8/21/24, LPA have followed up with the Department's certification unit to verify that documentation mailed was received, but they stated that they did not receive any renewal/new application documentation for any of both facilities.

During today's visit, LPA have a discussion with Administrative Assistant regarding this issue and was told that Licensee is waiting to fix the computer, so they will be able to submit required documentation via online, but they were not able to provide a date to do so. The Department have previously cited for this issue and will be reviewing the information obtained to determine further actions.

No deficiencies cited during today's meeting. Exit interview 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: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024
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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