496801684-3-12-2021-21-AS-KMOA-BZ6QWE-20210316123146

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496801684
Report Date: 03/12/2021
Date Signed: 03/12/2021 10:30:46 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
03/02/2021 and conducted by Evaluator Marisol Cuadra

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210302114039

FACILITY NAME:	AA BEST CARE HOMES		FACILITY NUMBER:	496801684
ADMINISTRATOR:	AQUINO, NICANOR		FACILITY TYPE:	740
ADDRESS:	857 HEARN AVE.		TELEPHONE:	(707) 546-8413
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95407
CAPACITY:	40	CENSUS: 30	DATE:	03/12/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Charito Santos (Administrator)		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility is mismanaging resident's medications

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisol Cuadra conducted a complaint investigation regarding the above allegations. Tele-visit with Administrator, Charito Santos was conducted due to COVID-19 precautions on March 12, 2021 and on this date for the purpose of closing the complaint.

During this investigation LPA conducted interviews, made observations and reviewed records. Based on records reviewed of medications conducted on 3/3/21 during tele-visit LPA/Administrator observed multiple medication errors involving residents (R1, R2, R3, R4 and R5). Facility provided resident’s Medication Assistance Records (MARs) for the month of March 2021 revealed resident's medications were listed but not initialed by staff. Also, Centrally Stored Medication Records printed on 3/3/21 indicated medication records has not been updated in the system by staff. LPA conducted interviews with staff (S1) on 3/8/21, S1 assures that residents were assisted with the administration of medications as prescribed per physician’s order. However, S1 could not provide any proof or explanation about the missing start date on resident’s bubble packs medication and in the Centrally Stored Medication Records.
Continues on LIC9099C...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20210302114039

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: 03/12/2021

NARRATIVE

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Continued from LIC9099...

S1 also informed LPA that the last time they received medication management training was back on 2018. LPA confirmed this information based on S1 medication management training records provided by facility, which indicates that S1 has not receive required annual continuation of medication training after 2018. However, CCL has not received Incident reports for medication errors.

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 being cited on the attached LIC 9099D. Appeal Rights Given.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20210302114039

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: 03/12/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/02/2021 Section Cited CCR 87465(h)(6)(D)	1 2 3 4 5 6 7	87465 (h)(6)(D) Incidental Medical & Dental Care.The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least 1 yr & includes: (D) The date filled. This requirement has not been met as evidence by:	1 2 3 4 5 6 7	Administrator/Licensee agrees to conduct a medication audit, retrain staff on medication management from an outside vendor & will write a plan to ensure resident medications are logged into the Centrally Stored Medication Records daily. Administrator to submit the updated plan to CCL by POC due date 4/2/21.
	8 9 10 11 12 13 14	Based on interviews with staff and record review Licensee failed to ensure proper management of medication. S1 was responsible for medication management of all residents in care, LPA/Administrator conducted a medication audit on 3/3/2021 & found multiple medication errors which poses a potential health & safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

LIC9099 (FAS) - (06/04)

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