<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801684
Report Date: 04/10/2025
Date Signed: 04/10/2025 12:00:19 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/28/2025 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250328130407
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: 24DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Charito Santos (Administrative Assistant)TIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Facility staff are not keeping residents free from infestation of bugs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Charito Santos, Administrative Assistant.

The Department received an anonymous complaint allegation of facility staff are not keeping residents free from infestation of bugs. Per anonymous complainant, facility staff don't care that residents are bitten up and look like they have a rash. The complainant stated that they have observed small smeared blood and what looked like bugs/ smashed bug pieces in the corner of the mattress liner/cover and unknown resident (names not provided) pulled up sleeves and there were little pinpoint bites and what looks like a rash that appeared to be caused by bed bugs or scabies, but there were smears of blood and dead small bugs in the corner of the mattress. On 4/1/25, LPA conducted 10-day visit to the facility made observations, reviewed records and conducted interviews with staff.
Continued on LIC9099C...

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 21-AS-20250328130407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 HOMES
FACILITY NUMBER: 496801684
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/11/2025
Section Cited
HSC
1569.269(a)(5)
1
2
3
4
5
6
7
Type A §1569.269 Enumerated rights; severability (a) Residents of RCFE shall have all of the following rights: (5) To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement has not been met as evidence by:
1
2
3
4
5
6
7

Licensee agrees to contract a pest control vendor to come to the facility to treat all resident’s rooms to ensure facility is offering a healthful and safe area to residents in care. Licensee will submit receipts as proof of service to CCL by POC due date.
8
9
10
11
12
13
14
Based on LPA record review and interviews conducted the facility did not ensure R1 was accorded safe, healthful, and comfortable accommodations which resulted in R1 have a bug infestation which poses an immediate health and safety risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20250328130407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 HOMES
FACILITY NUMBER: 496801684
VISIT DATE: 04/10/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continue from LIC9099...

Based on records review, the facility provided room treatment log revealing that the last room treated was #7 and #12 located in Wing A on 5/27/24 and 3/5/25 followed up with spray to room #12, 13, 11, 10 & 9 on 5/28/24, 5/29/24, 5/31/24, 6/2/24 & 3/4/25 respectively. Based on interviews conducted with Administrative Assistant and staff who performs the treatments, they tend to forget to document when they treat areas of the facility. However, they were unable to provide an exact date nor room of the last treatment. On 4/4/25, Licensing staff held an informal meeting with facility representatives where ongoing bed bugs issue was addressed. Licensee agreed to contact a pest control vendor to provide their services to help to get rid of bed bugs at the facility to ensure resident’s health and safety. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given. An immediate civil penalty in the amount of $250 will be issued for repeated violation within the last 12-month period.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3