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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801684
Report Date: 06/13/2022
Date Signed: 06/13/2022 11:40:10 AM

Document Has Been Signed on 06/13/2022 11:40 AM - 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: 30DATE:
06/13/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Charito Santos (Administrator)TIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Cuadra conducted an unannounced case management visit to cite deficiencies discovered during a complaint investigation and met with Administrator, Charito Santos.

LPA learned through records review and interviews conducted on 4/28/22 with Administrator that facility is not following doctor’s order for two (R1 and R2) out of four residents who doesn’t have a doctor’s prescription to smoke marijuana. Only one (R1) out two residents that have a doctor’s prescription on file, it was determined to be capable of handling their own medications. Per Administrator, they are aware that residents that have a doctor’s order on file keep in their personal possession the drug prescribed. However, marijuana is a prescribed drug and still needs to be centrally stored/locked and inaccessible to other residents in care. On 5/5/22 LPA Willis and LPM Moellers conducted a tele-visit office visit with Administrator and staff (S1) and additional staff were observed not wearing a face covering while in the premises as indicated in their current Mitigation Plan dated 1/14/21 after one or more residents in the facility were diagnosed with a communicable disease.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 06/13/2022 11:40 AM - It Cannot Be Edited


Created By: Marisol Cuadra On 06/13/2022 at 09:28 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 06/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2022
Section Cited
CCR
87470(a)(2)

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Type A 87470 Infection Control Requirements. A licensee shall ensure that inf. control practices are maintained as follows: a) when 1 or more residents in the facility are diagnosed with a communicable disease...: (2) All staff providing direct care to a resident who has a communicable disease shall wear appropriate PPE...This req has not met as evidence by
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Administrator agrees to retrain all staff and submit self-certification LIC9098 as proof of staff were notified and will be trained on proper PPE wearing as stated on their current mitigation plan by POC due date.
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Based on observations made during a tele-visit on 5/5/22 with Administrator did not ensure to follow their current Mitigation Plan dated 1/14/21 and were observed not wearing a mask after one or more residents in the facility were diagnosed with a communicable disease which poses an immediate risk to the health and safety of residents in care.
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Type B
06/27/2022
Section Cited
CCR87465(e)(1)(C)

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Type B 87465 Incidental Medical and Dental Care (e) For every prescription & nonprescription PRN med…there shall be a signed, dated written order from a physician maintained in the residents file, & label on the med.1)Meds shall be centrally stored...: (C) Because of potential dangers related to the med itself &
to be a safety hazard to others. This requirement has not been met as evidence by:
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Administrator will update doctor’s order for two out of four residents that smoke marijuana in the designated place in the facility and will centrally store the prescribed drug. Administrator will submit proof of doctor’s order on file by POC due date.
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Based on records review and interviews conducted with Administrator, the facility did not ensure that two out of four residents that smoke marijuana in the facility obtained a doctor’s order prior to be used by residents which poses a potential risk to the health and 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 Moellers
LICENSING EVALUATOR NAME:Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2022


LIC809 (FAS) - (06/04)
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