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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801684
Report Date: 08/03/2021
Date Signed: 08/03/2021 12:09:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 HOMESFACILITY NUMBER:
496801684
ADMINISTRATOR:AQUINO, NICANORFACILITY TYPE:
740
ADDRESS:857 HEARN AVE.TELEPHONE:
(707) 546-8413
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:40CENSUS: 31DATE:
08/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Charito Santos (Administrator)TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced, to conduct an Annual Required inspection and was greeted by Administrator, Charito Santos. The inspection is focused on the Infection Control procedures and practices of this facility.

Upon arrival, LPA observed that facility has posters on the front door indicating that visitors are not allowed. Once inside the facility, LPA observed that facility does have a sign-in for visitors and did screen LPA when they came in. LPA observed that staff were wearing masks during this visit. LPA conducted a walk-through of the facility and observed Covid-19 posters that included hand washing signs in restrooms. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer was observed throughout the facility. Commonly touched surfaces are disinfected throughout the day. LPA discussed visitation with staff who stated that residents only receive visits from their case workers and they have chairs available for residents to receive visitors outside. Facility has a designated isolation apartment on the facility premises. Facility staff have been trained on PPE protocols but have not yet been N-95 fit tested. Facility maintains a 30 day supply of medication. Facility has a 100% vaccination rate of staff, but 2 residents are not vaccinated. Residents are encouraged to wear masks when in the community.

Facility has submitted their Covid Mitigation Plan and approved on 5/18/21. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including masks, face shields, gowns and hand sanitizer.

LPA provided the following guidance:


  • Review PINs 21-28-ASC and 21-32-ASC for new guidance regarding visitation, communal dining, etc.
  • Get staff N-95 fit tested

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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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