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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801684
Report Date: 09/24/2021
Date Signed: 09/24/2021 11:10:27 AM

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: 30DATE:
09/24/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Nick Aquino (Licensee)TIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management Inspection and met with Licensee, Nick Aquino. LPA conducted risk assessment call with Licensee prior to visit. LPA arrived at the facility and had her temperature checked and was logged into a sign-in sheet.

LPA is following up regarding three incident reports received involving resident (R1) who had trouble breathing. On 9/19/21 R1 complained about difficulty breathing and was transported to Santa Rosa Memorial Hospital. R1 has a history of not being able to breathe and had been transferred to Hospital due to their smoking habits. During hospital visit was prescribed a nicotine patch to help them manage the smoking issue. Previously, R1 was instructed to limit cigarette intake and responsible party agreed with Administrator that no more money was going to be provided to R1 until their smoking habit changes.

During this visit LPA followed up on death certificates for 2 residents (R2 and R3) who were not receiving hospice care at the time of death. Licensee provided death certificate for R2 who passed away on 3/15/2021 and was not under hospice care. Death certificate indicated that R2's cause of death was adenocarcinoma of the lung with metastasis to right pleura and left lung. Death certificate for R3 who passed away on 8/27/21 is still pending and Licensee agreed to submit it as soon as they receive it.

The last incident involving R4 who on 9/17/21 around 5pm complained of having difficulty breathing, paramedics were called and resident was transported to Santa Rosa Memorial Hospital. Responsible parties were notified. R4 was prescribed with chronic sinusitis and new medication was ordered. During today's visit LPA confirmed that R4 is taking medication as ordered by their physician.

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

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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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