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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801684
Report Date: 10/07/2021
Date Signed: 10/07/2021 03:55:13 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: 30DATE:
10/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:52 PM
MET WITH:Charito Santos (Administrator)TIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management Inspection and met with Administrator, Charito Santos. LPA conducted risk assessment with Administrator 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 an incident report received on 10/5/21 involving resident (R1) had trouble breathing. On 9/26/21 R1 complained about difficulty breathing and was transported to Santa Rosa Memorial Hospital. R1 and was previously diagnosed with Chronic pulmonary disease and was prescribed with new medication albuterol 90mcg and budesonide-formoterol 160-4.5mcg. R1 has a history of not being able to breathe and had been transferred to Hospital due to their smoking habits. 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. As of today, R1 has not experienced any incidents. Administrator informed LPA that facility is working with resident's responsible party and case worker to help R1 to quit smoking.

During today's visit, LPA was informed by Administrator that facility contracted a vendor (Telecare) who was also present and will be conducting on 10/14/21 staff training for staff who assist residents with medications to help with medication management issues. Administrator agreed to submit staff training sign-in sheet to CCL by 10/15/21.

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: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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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