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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801684
Report Date: 02/13/2025
Date Signed: 02/13/2025 01:48:26 PM

Document Has Been Signed on 02/13/2025 01:48 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/
DIRECTOR:		AQUINO, NICANORFACILITY TYPE:
740
ADDRESS:857 HEARN AVE.TELEPHONE:
(707) 546-8413
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY: 40CENSUS: 24DATE:
02/13/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Charito Santos (Administrative Assistant)TIME VISIT/
INSPECTION COMPLETED:
02:03 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Cuadra and Deniz arrived unannounced for the purpose of conducting a case management to follow up on Administrator certificate and met with Administrative Assistant Charito Santos. Licensee Nick Aquino was not able to come to the facility due to been out of the country, but LPAs held a conversation via phone with Tiffany Dizon who is Administrator at their sister facility Mc Hugh Care Home.

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 have issued citations to the facility due to not having supporting evidence that submitted required documentation 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 number dated 7/25/24 with Sacramento department's address on it to CCL to clear the citation. However, on 12/5/24, LPA have followed up with the Department's certification unit to verify that documentation mailed was received, but they stated that they had staff trying to work with them to resolve their incomplete application for almost an entire year. After multiple notices the certification unit withdrew their application due to failure to follow up and comply with Administrator Certification renewal requirements and lack of communication to remediate their application in a timely manner for both facilities.

During today's visit, LPAs have a discussion with Tiffany via phone regarding this issue and was told that it has been hard to appoint a certified administrator to fill out the administrator position, which it has been the same reason given to the Department on 12/6/24 by Nick. Per Tiffany, Nick has completed and submitted Administrator certificate for further processing. However, Licensee keep failing to follow up on their submitted application to the certification unit. LPA will be issuing a citation and civil penalties on the amount of $250. Licensee have been informed that if they don't comply with regulations additional civil penalties will be warrant until this issue gets resolved.Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Exit interview was conducted with Administrative Assistant and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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Document Has Been Signed on 02/13/2025 01:48 PM - It Cannot Be Edited


Created By: Marisol Cuadra On 02/13/2025 at 01:17 PM
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: 02/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2025
Section Cited
CCR
87405(a)

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87405 Administrator - Qualifications and Duties 87405 (a) All facilities shall have a qualified and currently certified administrator. This requirement is not met as evidenced by:
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Licensee will appoint a certified administrator for this facility and will submit required documentation to perform this change to the Department by POC due date 2/28/25. Licensee have been informed that if they don't comply with regulations civil penalties will be warrant until this issue gets resolved. A civil penalty in the amount of $250 issued.
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Based on LPA's/Licensee observation, interviews and record review, the licensee did not comply with the section cited above in that Licensee/Administrator keeps failing to follow up with the Department Certification Unit, which poses an immediate health, safety, or personal rights risk to persons 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: 02/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2025


LIC809 (FAS) - (06/04)
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