Mc Hugh Care Home

Allegation investigated: Facility did not follow mandatory reporting requirements

At approximately 9:30 AM, Licensing Program Manager (LPM) Victoria Bertozzi and Licensing Program Analyst (LPA) Robert Frank arrived to deliver Complaint findings regarding the above allegation and met with Licensee Tiffany Dizon. During the course of the investigation LPA conducted multiple facility visits, conducted interviews, collected and reviewed documents. On 6/29/2026 Community Care Licensing (CCL) received an SOC 341 Report of Suspected Dependent Adult/Elder Abuse. The SOC 341 was submitted by Witness W1. Witness W1 is not an employee of Mc Hugh Care Home. The SOC 341 stated that facility resident R1 was assaulted by resident R2. Resident R1 stated that they believe that they were assaulted by resident R2 because they were ignoring them. On 7/14/2026 facility staff member S1 stated that they were not aware of R2 assaulting R1 at the time but just recently heard about the incident. Continued on 9099-C... Substantiated ...Continued from 9099 On 7/14/2026 facility staff member S2 stated that they were aware of the incident. S2, when asked if they knew about R2 assaulting R1 they stated, “Yes, R1 came up to me after the incident.” When S2 was asked if they called the police they stated, “no, R1 didn’t want anyone to be called. Per regulations, the facility should have filed a LIC 624 Unusual Incident/Injury Report. Additionally, the facility should have filed an SOC 341 Report of Suspected Dependent Adult/Elder Abuse document. Based on LPA’s interviews and record review, 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, are being cited on the attached 9099Dthe state’s words, verbatim · CDSS document, Aug 7, 2026 · control 21-AS-20260630093143

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Aug 10, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports...including...(1) A written report shall be submitted...This report shall include...(D)Any incident which threatens the welfare, safety or health of any resident, ... This requirement is not met as evidenced by: Based on interview & record review, the licensee did not comply with the section cited above in that facility staff did not file a LIC 624 Unusual Incident/Injury Report with CCL which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: Facility is closing. Deficiency will be cleared during today's visit.

Allegation investigated: Resident was denied food by the facility staff Facility staff yell at the resident

At approximately 9:30 AM, Licensing Program Manager (LPM) Victoria Bertozzi and Licensing Program Analyst (LPA) Robert Frank arrived to deliver Complaint findings regarding the above allegations and met with Licensee Tiffany Dizon. During the course of the investigation LPA conducted multiple facility visits, conducted interviews, collected and reviewed documents. Complaint alleges that resident R1 was denied food by the facility staff and that facility staff yell at residents. Witness W3 stated on 6/17/2026 at approximately 4:30 PM, resident R1 was asked by staff member S1 if they wanted their dinner. W3 stated that resident R1 replied that they were not hungry as they were still full from breakfast and lunch. At some point between 6:30 PM and 7:45 PM resident R1 knocked on staff member S1’s door requesting food. Witness W3 stated that staff member S1 was sleeping at that time. Witnesses W1 and W3 stated that staff member S1 yelled at R1 stating the kitchen is closed. S1 further stated that the facility is not a restaurant and that they can’t order food at any time. Continued on 9099-C... Substantiated ...Continued from 9099 Resident R1 was not served dinner on 6/17/2026. When asked what time meals are served, staff member S2 stated, “Breakfast is 7:00 AM to 7:30 AM, but we don’t impose the time. Some (resident) eat breakfast at 10:00 AM. Lunch is from 10:30 AM to 11:00 AM. Dinner is from 4:00 PM to 5:00 PM, but we don’t really enforce the times.” When asked what time the kitchen closes, staff member S1 stated, “dinner starts at 4:00 PM and the kitchen closes at 5:30 PM.” In resident R1’s Admission Agreement, under House Rules, rule number twenty (20) lists the following mealtimes: “Breakfast 7:30 AM, Lunch 11:30 AM, Dinner 4:30 PM. Kitchen is closed promptly at 8:30 PM” Resident R1 requested their meal between 6:30 PM and 7:45 PM, before the 8:30 PM closing time stated in the admissions agreement. Witnesses W1 and W3 provided corroborating statements that staff member S1 yelled at resident R1. Based on LPA’s interviews and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D. Exit interview conducted. Copy of LIC9099, LIC9099C, LIC9099D, Plan of Corrections and Appeal Rights discussed and provided to Licensee Dizon. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 7, 2026 · control 21-AS-20260618141658

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(1) · Plan of correction due date: Aug 10, 2026

87555 General Food Service Requirements (b)The following food service requirements shall apply:(1) Where all food is provided by the facility arrangements shall be made so that each resident has available at least three meals per day. ... This requirement is not met as evidenced by: Based on interview & record review, the licensee did not comply with the section cited above that Resident R1 was not provided dinner on 6/17/2026 which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: Facility is closing. Deficiency will be cleared during today's visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Aug 10, 2026

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above in that staff member S1 yelled at resident R1 which poses a Potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: Facility is closing. Deficiency will be cleared during today's visit.

Type of visit: Case Management - Other

At approximately 9:30 AM Licensing Program Manager (LPM) Victoria Bertozzi and Licensing Program Analyst (LPA) Robert Frank arrived at the home for the purpose of voluntary closure of this licensed Residential Care Facility for the Elderly and met with Licensee Tiffany Dizon. The licensee initiated this facility closure with plans of closing due to plans of no longer wanting to operate as a licensed facility. LPA inspected all rooms and the exterior of the building and found no evidence that would suggest that clients are residing on the premises. Closure of this facility has been finalized. Facility was closed effective 08/7/2026. Licensee turned over copy of License during today's inspection. Exit interview conducted. Copy of report provided to Tiffany Dizon.the state’s words, verbatim · CDSS document, Aug 7, 2026

Type of visit: POC

At approximately 1:40 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced, to conduct a Plan of Correction (POC) visit. On 6/30/2026, LPA issued a citation for a violation of California Code of Regulation section 87465(h)(5) with a plan of correction (POC). The POC called for the Licensee to provide proof that facility staff members S1 and S2 had taken their required annual Medication management training to Community Care Licensing (CCL) by POC due date of 7/1/2026. As the licensee failed to submit the proof of training by the POC due date, the facility will be assessed a civil penalty for $100 per day for the period of 7/2/2026 to 7/14/2026 totaling $1300. The civil penalty will continue to accrue $100 per day until the deficiency is corrected. Failure to correct the cited deficiency will result in further civil penalty assessments. Exit interview conducted. Copy of report, LIC-811 Confidential Names, LIC 421FC, provided to Caregiver Gallardo. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 14, 2026

Type of visit: Required - 1 Year

At approximately 1:00 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year inspection and was greeted by Caregiver (CG) Rodrigo Gallardo. Mc Hugh Care Home is licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for fifteen (15) Residents, eleven (11) of whom may be non-ambulatory. There is a hospice waiver for one (1) Resident. Upon arrival, LPA was informed that there were eight (8) Residents in care and two (2) staff members on-site. LPA reviewed the Facility's Staff Roster and observed that all staff on-site were background cleared and associated to the facility per regulation. LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided CG Gallardo. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 19, 2026

Type of visit: Office

An office meeting was conducted today in the Santa Rosa Regional Office with Licensing Program Manager Victoria Bertozzi, Licensing Program Analyst Robert Frank and facility representatives, Nicanor Aquino and Tiffany Dizon. Parties previously met on 6/1/2026 to discuss the plan for this facility moving forward from the death of the Licensee. Facility has provided the following documents: Control of property Facility representatives need provide the following documents: Death certificate for Licensee Angelita Aquino Facility has been issued an Emergency Approval to Operate and has submitted an application with the Central Applications Bureau. No deficiencies cited during today's office meeting.the state’s words, verbatim · CDSS document, Jun 3, 2026

Type of visit: Office

An office meeting was conducted today in the Santa Rosa Regional Office with Licensing Regional Manager, Carla Nuti-Martinez, Licensing Program Managers Bethany Moellers and Victoria Bertozzi, Licensing Program Analysts Robert Frank and Marisol Cuadra and facility representatives, Nicanor Aquino and Tiffany Dizon regarding the Emergency Approval to Operate (EAO) for this facility and the Licensee's other facility, AA Best Care 496801684. The Licensee passed away, Nicanor Aquino and Tiffany Dizon will continue the operation of this facility. On 4/4/25, Licensing staff held an informal conference with facility representatives to discuss possible options that they could choose to continue the operation of both facilities due to Licensee’s Angelita Aquino health challenges. Based on records review, LIC309 Administrative Organization form indicates that Angelita Aquino is the Licensee for this facility. At that date, facility representatives indicated their interest in creating a new corporation or LLC and submit a change of ownership application to the department for both facilities by not later than May 4, 2025. During todays meeting facility representatives have stated their intention to close this facility within ninety (90) days. During today's meeting it was advised to proceed with the EAO and Regional Office will follow up with further information. Facility representatives provided the following documents with the intent of continuing operation of the facility: - LIC200. - LIC500. - Control of property – Trust Documents. - Fire Clearance Sketch (LIC999) - Infection Control Plan. Continued on 809-C... ...Continued from 809 Facility representatives need provide the following documents: -Death certificate for Licensee Angelita Aquino. -Updated Lease showing control of property No deficiencies cited during today's office meeting.the state’s words, verbatim · CDSS document, Jun 1, 2026

Allegation investigated: Facility is not safeguarding resident’s personal property.

At approximately 1:40 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver Complaint findings regarding the above allegation and met Caregiver (CG) Rodrigo Gallardo. During the course of the investigation LPA conducted multiple facility visits, conducted interviews, collected and reviewed documents. Complaint alleges facility is not safeguarding resident’s personal property. A witness (witness W1) reported that a client of the facility (client C1) told them that sentimental and valuable personal property was stolen from them at the facility. Witness W1 contacted the Santa Rosa Police Department (SRPD) and asked them to investigate. During their investigation a SRPD Officer went to the facility to interview client C1. The officer reported that client C1 did not want to provide any information. Continued on 9099-C... Unsubstantiated ...Continued from 9099 During the investigation, LPA conducted two (2) facility visits. During these visits LPA attempted to interview client C1. In both instances, client C1 did not want to provide any information regarding the investigation to the LPA. In both instances client C1 referred the LPA to speak with witness W1 for information pertinent to the investigation. LPA interviewed two (2) staff members (S1 and S2) of the facility. Both S1 and S2 stated that client C1 did not report the alleged theft to them. As client C1 did not wish to speak with the SRPD or with the investigating LPA, the only information the LPA was able to gather was hearsay. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to CG Gallardo. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Mar 4, 2026 · control 21-AS-20260112155325

Type of visit: Case Management - Other

At approximately 11:50 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver an amended document from a Case Management visit conducted on 10/9/2025. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Caregiver Buenaflor. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Dec 12, 2025

Type of visit: Office

An informal meeting was conducted today in the Santa Rosa Regional Office as requested by facility representatives Nicanor and Tiffany Dizon. Present in the meeting were Licensing Program Manager Victoria Bertozzi, Licensing Program Analysts Marisol Cuadra, Robert Frank, other representatives Nicanor Aquino and Tiffany Aquino. During today’s meeting it was discussed further management for this facility and the Licensee's other facility, AA Best Care 496801684. Also, areas of concern regarding acting administrator and involvement in the facility operation. On 4/4/25 during an informal meeting conducted options were given to facility representatives for them to choose from to continue the operation of both facilities. Representatives agreed to submit a change of ownership application to the Department Centralized Application Bureau (CAB). Co-Licensees provided updated email address for both facilities. The administrator was informed that other representatives need to be associated with the facility. No deficiencies cited during today's office meeting. Exit interview conducted with the representatives and a copy of this report was given.the state’s words, verbatim · CDSS document, Oct 29, 2025

Type of visit: POC

**Document has been Amended to reflect that the Civil Penalty of $4200.00 has been rescinded. At approximately 2:15 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced , to conduct a Plan of Correction (POC) visit. On 8/22/2025, LPA issued a citation for a violation of California Code of Regulation section 87405(a) with a plan of correction (POC). The POC called for the Licensee to provide the documents required to make a currently certified administrator the active Administrator of the facility to Community Care Licensing (CCL) by POC due date of 8/25/2025. Exit interview conducted. Copy of report, provided to Caregiver. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Oct 9, 2025

Type of visit: POC

At approximately 2:10 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced, to conduct a Plan of Correction (POC) visit. On 8/22/2025, LPA issued a citation for a violation of California Code of Regulation section 87405(a) with a plan of correction (POC). The POC called for the Licensee to provide the documents required to make a currently certified administrator the active Administrator of the facility to Community Care Licensing (CCL) by POC due date of 8/25/2025. As the licensee failed to submit the documents by the POC due date, the facility will be assessed a civil penalty for $100 per day for the period of 8/26/2025 to 08/28/2025 totaling $300. The civil penalty will continue to accrue $100 per day until the deficiency is corrected. Failure to correct the cited deficiency will result in further civil penalty assessments. Exit interview conducted. Copy of report, LIC 421FC, provided to Caregiver Buenaflor. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 28, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Robert Frank arrived unannounced for a Case Management visit. The facility is being cited for not having a currently certified Administrator. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections and Appeal Rights discussed and provided to Caregiver Yolanda Buenaflor. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 22, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Aug 25, 2025

87405 Administrator - Qualifications and Duties (a)All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in that the facility does not have a currently certified Administrator which poses an immediate health, safety or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Aug 22, 2025

Plan of correction: Licensee will provide the documents required to make a currently certified administrator the active Administrator of the facility to Community Care Licensing by the POC due date of 8/25/2025.

Allegation investigated: Physical Plant

Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver findings regarding the above allegation and met with Caregiver Rodrigo Gallardo. Complaint alleges that rodents are present in the facility kitchen and kitchen cabinets. During facility inspection on 5/23/2025 LPA observed a large rodent bait station under the dishwasher door. Staff member S1 stated that they placed the bait station in the observed position. LPA further observed rodent feces on the floor of the pantry next to the kitchen and on top of canned goods within said pantry. LPA also observed rodent feces in the closet used to store food products outside of Bedroom #2 as designated on the facility sketch. LPA obtained photos of noted bait station and pantry area. LPA conducted interviews with facility residents. Residents R1, R2 and R3 all stated that they have recently seen rodents in the facility. During an investigation visit on 7/14/2025 LPA observed rodent feces on top of canned goods in the pantry next to the kitchen. LPA obtained photographs during all investigation visits. Continued on 9099-C... Substantiated ...Continued from 9099 Based on LPA’s observations and record review, 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, are being cited on the attached 9099D. Exit interview conducted. Copy of report, LIC-9099-D, Plan of Corrections and Appeal Rights discussed and provided to Caregiver Gallardo. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 31, 2025 · control 21-AS-20250421123325

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(27) · Plan of correction due date: Aug 21, 2025

87555 General Food Service Requirements (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above in that rodents, rodent feces and a rodent trap were observed in the kitchen and kitchen pantry areas which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 31, 2025

Plan of correction: Licensee or Administrator shall submit a plan on what changes will be made to the facility’s physical plant and or operational procedures that will ensure that the facility be kept free of rodents, vermin and insects by POC due date of 8/21/2025.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Robert Frank arrived unannounced for a Case Management visit. The facility is being cited for not having a currently certified Administrator. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections and Appeal Rights discussed and provided to Caregiver Gallardo. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 31, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Aug 1, 2025

87405 Administrator - Qualifications and Duties (a)All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in that the facility does not have a currently certified Administrator which poses an immediate health, safety or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Jul 31, 2025

Plan of correction: Licensee will provide the documents required to make a currently certified administrator the active Administrator of the facility to Community Care Licensing by the POC due date of 8/1/2025.

Type of visit: Required - 1 Year

At approximately 8:45 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year inspection and was greeted by Caregiver (CG) Rodrigo Gallardo. Mc Hugh Care Home is licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for fifteen (15) Residents. Eleven (11) Residents can be non-ambulatory. There is a hospice waiver for one (1) Resident. Upon arrival, LPA was informed that there were eight (8) Residents in care and two (2) staff members on-site. At approximately 9:15 AM, LPA reviewed the Facility's Staff Roster and observed that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:20 AM, LPA toured the facility with CG Gallardo. All exits were clear and unobstructed. The facility has three (3) fire extinguishers. Two (2) extinguishers were last serviced in 5/2024. One (1) extinguisher was observed to be last serviced in 6/2023. All extinguishers need to be serviced and tagged annually. This deficiency will be cited. The fire alarm and sprinkler system was serviced in 12/2024. Food supply was sufficient. The facility was sufficiently lighted. LPA inspected four (4) Resident bedrooms and observed all to have sufficient lighting and furnishings as required per Title 22 Regulations. The sliding screen doors in bedroom one (1) and in bedroom four (4) were observed to be damaged. This deficiency will be cited. LPA observed a badly broken window in bedroom seven (7). The window was observed to have been partially covered with cardboard and duct tape. This deficiency will be cited. The facility was previously cited for the same deficiency on 7/2/2024. As the deficiency has been cited twice in under twelve (12) months, a Civil Penalty will be assessed for the facility not being in good repair. Continued on 809-C... ...Continued from 809 There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. LPA observed two sauce containers that were opened and partially used in the kitchen pantry. Both sauces required refrigeration after opening. This deficiency will be cited. LPA further observed in the same pantry several food cans that had rodent feces on their top. This deficiency will be cited in Complaint 21-AS-20250421123325. In the closet outside of bedroom two (2) LPA observed unsecured prescription medication for a Resident who is no longer admitted to the facility. This deficiency will be cited. The facility was previously cited for the same deficiency on 12/6/2024. As the deficiency has been cited twice in under twelve (12) months, a Civil Penalty will be assessed for the unsecured medication. All other toxins were observed to be stored inaccessible to Residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is not conducting fire and emergency drills per regulation with the last disaster drill having taken place in July, 2024. This deficiency will be cited. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were observed to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. LPA observed spider webs and dirt on the floors of the facility's common areas. At approximately 11:45 AM, LPA reviewed four (4) Resident files. LPA observed that Three (3) of four (4) Residents (R2,R4,R5) did not have current appraisal & needs service plans. For R2, R4 and R5 the last appraisal & needs service plan was dated 5/9/2023. One (1) Resident (R3) did not have any appraisal & needs service plan or signed Personal Rights documents in their file. These deficiencies will be cited. LPA reviewed two (2) staff files. Two (2) staff members (S1,S2) did not have proof of annual training on file. This deficiency will be cited. One (1) staff member (S1) did not have current First Aid or CPR certification. This deficiency will be cited. LPA spot checked Medication for three (3) Residents. LPA observed all medications to be centrally stored, secure and with proper documentation. Resident’s monies for personal and incidental items are not maintained by the facility. Continued on 809-C(2)... ...Continued from 809-C Administrator Tiffany Dizon's Administrator Certification is not current. LPA requested the following documents be submitted to Community Care Licensing by 6/23/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809Ds, LIC 421FCs, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to CG Gallardo. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 23, 2025

Type of visit: Office

An informal meeting was conducted today in the Santa Rosa Regional Office. Present in the meeting were Regional Manager Carla Nuti-Martinez, Licensing Program Manager Victoria Bertozzi, Licensing Program Analysts Marisol Cuadra, Christi Coppo, Robert Frank and representatives of the facility, Administrators Nicanor Aquino and Tiffany Dizon, Justice Dizon and Jasmin Dizon, via phone Nikki Aquino. The purpose of the informal conference is to address concerns regarding further operation and management for this facility and the Licensee's other facility, AA Best Care 496801684 in which Nicanor Aquino is the identified Administrator. Also, areas of concern regarding medication management. During today’s meeting it was discussed with Administrators the possible options that they can choose to continue the operation of both facilities due to Licensee’s Angelita Aquino health challenges. Facility documents on file indicate Angelita Aquino is the Licensee for this facility. The current options discussed are the following: -Submit a change of ownership application to the Centralized Application Bureau (CAB) for both facilities. Administrators informed that they will be submitting change of ownership application to CAB by not later than May 4, 2025. CAB contact information was provided. Administrator were informed that other representatives need to be associated to the facility. Licensing staff discussed Technical Support Program (TSP) that offers advice, guidance, a review of facility operation, discusses best practice, and required regulation/hsc compliance. No deficiencies cited during today's office meeting. Exit interview conducted with Administrators and a copy of this report was given.the state’s words, verbatim · CDSS document, Apr 4, 2025

Allegation investigated: Staff withheld medication from resident in care

At approximately 9:00AM, Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with caregiver. Nick Aquino arrived later but then left. He gave caregiver permission to sign. Complaint alleges staff withheld medication from resident in care. Complainant alleges that resident (R1) was not given their morphine medication on the morning of their death. Complainant alleges that the medication was purposefully withheld due to the staff’s (S1 and S2) religious beliefs. During investigation, LPA interviewed outside party that suspected morphine was not given per orders on the morning of resident (R1) death. Per interview on 3/20/25, S2 advised LPA that giving morphine is a mortal sin, as they are a practicing Catholic and they will not give that medicine becuase residents might die from receiveing it. Continued on 9099C... Unsubstantiated Continued from 9099... However, per interview on 12/20/24 with S1, LPA was advised that R1 did receive the necessary morphine on the morning of R1's death. S2 advised LPA that S1 gave R1 the morphine that morning, and because of this being a mortal sin, S1 later went to confession to confess the sin and ask for forgiveness. During investigation, LPA conducted interviews. LPA did not receive any reports of medication being withheld or observing any medications being withheld from residents. LPA asked for medical destruction record and MAR for the administration of morphine for R1. Facility could not produce the morphine medical destruction record for R1. LPA attempted to verify medication administration and destruction records with hospice company but was unsuccessful. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with caregiver. A copy of this report given. No deficiencies cited.the state’s words, verbatim · CDSS document, Mar 20, 2025 · control 21-AS-20241210103623

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Cuadra and Frank arrived unannounced for the purpose of conducting a case management to follow up on Administrator certificate and met with staff Rodrigo Gallardo. Licensee Nick Aquino was not able to come to the facility, but gave authorization to staff to sign the report. 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, AA Best Care 496801684 in which Licensee Nick Aquino is the identified Administrator. During annual inspection on 7/23/24, LPA issued a citation 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 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, LPA have a discussion with Licensee via phone regarding this issue and was told that it has been hard to appoint a certified administrator to fill out the administrator position. Per Nick, the hours needed to be completed to have their administrator certificate had been completed and they are in the process to submit required documentation for further processing. Continues on LIC809C... Continued from LIC809... However, Licensee agreed to appoint a certified administrator who will spend at least 20 hours in each facility. LPAs will be issuing a citation and Licensee have been informed that if they don't comply with regulations civil penalties will be warrant until this issue gets resolved. Upon arrival, LPAs observed two caregivers were cleaning the facility and there was an unattended Timolol Maleate 0.5% eye drop medication sitting on a table located in the common area where a resident was sitting watching tv. LPAs inquired with staff and were told that they just assisted another resident with medication, but did not put the medication in the locked medication cart. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with Licensee via phone and a copy of this report was given.the state’s words, verbatim · CDSS document, Dec 6, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Dec 7, 2024

87465(h)(2) Incidental Medical & Dental Care: (h) The following requirements shall apply...(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Based on LPA's/staff observation and interviews conducted with staff, Licensee did not ensure medications to be kept locked and inaccessible to residents. This is an immediate health & safety risk to residents.the state’s words, verbatim · CDSS document, Dec 6, 2024

Plan of correction: Staff removed R1's medication and locked during the visit. Licensee to submit documentation of staff training on regulation 87465(h)(2) with date, time, subject, duration, staff names and signatures of attendance by POC due date 12/7/24 to CCL to clear the citation.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Dec 16, 2024

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: Based on LPA's/Licensee observation, interviews and record review, the licensee did not comply with the section cited above in that Nick Aquino does not have a certified administrator from CCL, which poses a immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 6, 2024

Plan of correction: 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 12/16/24. Licensee have been informed that if they don't comply with regulations civil penalties will be warrant until this issue gets resolved.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Inspection and met with staff Rodrigo Gallardo. Acting Administrator, Nick Aquino arrived later. LPA/staff initiated a tour of the facility at 1:30 pm and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Water temperature in resident bathrooms measured at 106.9, 105.1 and 106.6 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked. Fire extinguisher was last inspected May, 2024. Smoke alarms and carbon monoxide detectors were found operational. According to acting administrator, there are no disaster drill been conducted during this year (technical violation had been issued). Facility has a fire pull system. The last fire department visit was conducted on June 2024. Resident rooms were furnished per regulation. At approximate 1:45pm LPA/acting administrator observed spider webs in resident's rooms (room #3 & room #2) and common areas. Window screen on room #3 needs to be replaced. All garbage cans do need to have a lid cover. Two out of three bathrooms were observed dirty and needing minor repairs on walls. At approximate 1:50pm LPA/acting administrator observed hallway closet where toxins are stored was unlocked during inspection. Staff immediately locked the laundry room area. Technical violation will be issued. Continued on LIC809C... Continued from LIC809... File review was initiated at 2:00 pm. Two staff files and five resident files were reviewed. One out of two staff do not have required First Aid and CPR certificates on premises (Technical violation was issued). Three out of five resident's care plan had not been updated within the last 12 months. During file review, LPA noticed resident (R1) was sent to the emergency room on May 2024. However, the Department was not notified about incident. LPA/acting administrator had a discussion regarding reporting requirements (technical violation was issued). Medications and medication records were reviewed. On 6/28/23, The Department held an informal meeting in the Santa Rosa Regional Office with acting Administrator, Nicanor Aquino and Licensee Angelita Aquino to address concerns regarding administrator certification for this facility and the Licensee's other facility (AA Best Care 496801684) in which Nicanor Aquino is the identified Administrator. During the office visit, it was determined that Licensee Angelita Aquino have submitted training documents to the Administrator Certification Unit to renew their Administrator Certificate and it was agreed that acting administrator upon completing their required training hours, they will submit their renewal application. However, during today's visit, it was revealed that administrator certificate for acting administrator, Nicanor Aquino 6010494740 is still expired and Licensee are in the process of completing required training hours. Although, they claim that they are taking required training hours, there is no supporting evidence that they have submitted any required documentation for the Department to review, LPA was unable to find their names listed on the Department's pending/approved administrator certificate List. The Department will be reviewing the information obtained to determine if further actions are needed. Licensee/acting Administrator to submit updates of the following documents by 7/16/2024: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), copy of Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with acting Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Jul 2, 2024

The state marks this report as 8 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.