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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801684
Report Date: 08/29/2024
Date Signed: 08/29/2024 01:49:46 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
07/25/2024 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240725143740
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
UNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Charito Santos (Administrative Assistant)TIME COMPLETED:
02:04 PM
ALLEGATION(S):
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-staff did not meet resident's hygiene and grooming 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 staff did not meet resident's hygiene and grooming need. Per Reporting party, resident (R1) was transferred to another licensed facility on 7/23/24. Upon arrival, the receiving facility stated that R1 arrived with extreme matted, and lice infested hair. On 8/8/24, LPA received written statements dated 8/2/24 from the receiving facility identifying R1’s admission as of 7/23/24 and detailing their nurse (LVN) intake assessment findings of hair, nails, and body as follow: “the assessment of resident’s head is conducted at the facility for any signs of dandruff, psoriasis, lesions, open wounds and/or lice. However, they were unable to perform the assessment due to R1’s hair being severely matted on both the top and bottom halves of their head, each standing up to about 3 to 4 inches off their head.
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: 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.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 21-AS-20240725143740
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: 08/29/2024
NARRATIVE
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Continued from LIC9099...

They assessed along their hair line due to severity. R1 had a crown on the top of their head and a clip of the back, which were difficult to remove, but once done, they applied conditioner to soften the hair. At that time, they were able to open the matted hair into two halves and noticed the infestation of lice and knits. Staff took turns to work on R1’s hair for almost four hours to complete the removal of lice.” A picture of hair was provided to the Department as well as another written statement signed by receiving facility house manager confirming the same information. During this investigation, the facility provided LPA with R1’s physician report dated 1/19/24 indicating that R1 was able to care for themselves and perform all. However, based on records review of R1’s admission agreement, it was agreed by the facility and R1 that the facility will assist with daily living activities including hygiene and grooming needs. Also, R1’s care notes revealed that on 7/2/24 staff smelled bad odor coming from R1’s clothing and body. Per daily care notes, staff requested to R1 to take a shower, but R1 refused to take a bath. The facility did not assist R1 with hygiene and grooming needs as agreed in their admission agreement. After reviewing incident reports log from the facility, LPA was unable to find any reports made to R1’s responsible parties including CCL about this incident and no further details were documented into the facility daily care notes regarding R1’s not taking showers. On 7/23/24 R1 was evicted from the facility due to unrelated reasons to this complaint. 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. An immediate civil penalty in the amount of $250 will be issued for repeated violation within the last 12-month period.
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
LIC9099 (FAS) - (06/04)
Page: 2 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, 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
07/25/2024 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240725143740

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
UNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Charito Santos (Administrative Assistant)TIME COMPLETED:
02:04 PM
ALLEGATION(S):
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-staff did not provide adequate laundry services.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegation and met with Administrative Assistant, Charito Santos.

Regarding the allegation of staff did not provide adequate laundry services. Per Reporting party, resident (R1) was transferred to another licensed facility on 7/23/24. Upon arrival, the receiving facility provided a written statement indicating that R1 have arrived at their facility with five garbage bags of clothing, belongings were soiled with urine and rat feces. Based on records review of the facility daily care notes of resident (R1), the facility washed R1’s clothing on a weekly basis as agreed on their admission agreement. Although, the facility staff disclosed that R1 have a preference of piling up their clothing there is no supporting evidence that could revealed that any urine or rat dropping could be present, or incidents above mentioned have happened at a prior date. A finding that the complaint allegation of staff did not provide adequate laundry services is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations 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: 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.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20240725143740
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: 08/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2024
Section Cited
HSC
1569.269(a)(5)
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§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 assisting resident’s needs including hygiene and grooming timely to CCL by POC due date. **Immediate Civil Penalty assessed in the amount of $250.
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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 sustained extreme matted, and lice infested hair 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: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4