Bonhurst Assisted Living. Corp. (House II)

Type of visit: Required - 1 Year

On 09/28/2026, Licensing program analyst (LPA) Marisa Chiarelli arrived to the facility unannounced to conduct a one year required inspection. LPA Chiarelli met with Angelina Skevig and explained the purpose of the visit. LPA Chiarelli and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured included but not limited to, residents bedrooms, bathrooms, and kitchen. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. Medication is kept in a locked cabinet. LPA Chiarelli reviewed two residents medications. Staff files are kept at sister facility Bonhurst Assisted Living Corp ( House II). LPA Chiarelli reviewed staff files at House II. The common area was clean, odor-free and in good repair. All bedrooms had required furniture, bedding, and lighting. The bathrooms were clean and in good repair. The kitchen was clean and in good repair. Sharps are kept in a locked drawer. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke and carbon monoxide detectors are all in working order. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. No firearms are on premises. No deficiencies are being cited on today's inspection, exit interview conducted and copy of report left with the administrator.the state’s words, verbatim · CDSS document, Sep 28, 2026

Allegation investigated: Staff are mismanaging residents' medications Staff are not providing incontinence care to residents in need

On 08/18/2026 licensing program analyst (LPA) Marisa Chiarelli arrived at the facility unannounced to deliver final complaint findings. LPA Chiarelli met with administrator Angelina Skevig and explained the purpose of the visit. Allegation: Staff are mismanaging resident’s medications Findings Substantiated While investigating the allegation “staff are mismanaging resident’s medications” LPA Chiarelli and administrator Skevig conducted a medication review on residents one (R1) medication. In the medication review LPA Chiarelli found several inconsistencies in the MAR used by the facility when the LPA Chiarelli asked the administrator why the facility had not properly filled out the MAR the administrator stated, “I have been to busy.” Substantiated Allegation: Staff are not providing incontinence care to residents in need Findings Substantiated While investigating the allegation “staff are not providing incontinence care to residents in need” LPA Chiarelli interviewed three (3) persons and reviewed documentation. During one interview it was stated that “nurses who came into the facility have found patients soiled.” In another interview the interviewee stated “that R1 may be incontinent but the facility does not have R1 wear depends just a pad on the bed for leakage.” Based on investigation observations, record review(s) and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegations is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Appeal rights were explained and provided to the facilitythe state’s words, verbatim · CDSS document, Aug 18, 2026 · control 59-AS-20260624133439

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 15, 2026

87465 Incidental Medical and Dental Care....(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. The licensee did not comply with the section cited above as evidenced by: Record review, interviews and observation. The staff did not give the resident their medication as prescribed per the physician orders, which poses a health, safety or personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Aug 18, 2026

Plan of correction: Licensee will conduct a MAR and medication training with all staff.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: Sep 15, 2026

87625(b)(3) Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. The licensee did not comply with the section cited above as evidenced by: Observation and interviews. Several residents incontinence needs were not being taken care which poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 18, 2026

Plan of correction: Licensee will conduct an incontinence care training with all staff.

Allegation investigated: Facility did not issue the refund for June 2025.

On 08-27-25, Sarah Benson, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 06-06-25. LPA Benson met with Administrator, Angelina Skevig and explained the purpose of the visit. During the interview process staff were interviewed and documents were reviewed. The following documents were received and reviewed: resident admission agreement, R1’s Medical Administrative Record (MAR), R1’s physicians report (LIC 602), Hospice records and Staff roster with phone numbers. Continued on LIC9099C and LIC9099D. Substantiated Facility did not issue the refund for June 2025. LPA reviewed resident records and conducted extensive interviews. Record review revealed a 30-day notice to vacate the facility was delivered on 5-22-25. Review of the admission agreement reveal a notice stating "This agreement remains in effect after the death of the resident: payment is owed until the following conditions are met: Balance is paid and the room is vacated, "Hospice Care". The Admission Policy states, "I also understand that Bonhurst Assisted Living Corporation will no longer provide any refund for a Direct Hospice Admission in case of death for any circumstances of her stay in the facility". LPA was able to determine R1 was moved from the facility with personal belongings on 5-30-25 and no refund was issued. In addition, Health and Safety Code §1569.652 states facilities are required to refund responsible party within 15 days once their personal belongings have been removed. Based on investigation observations, record review(s) and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Appeal rights were explained and provided to the facility representative listed above and exit interview conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.the state’s words, verbatim · CDSS document, Aug 27, 2025 · control 59-AS-20250606105519

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Nov 27, 2025

1569.652 Termination of admission agreement. ...(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: The responsible party gave a 30 day notice to vacate on 5-22-25. The residents belongings were removed on 5-30-25. The residents paid fees were not returned within the 15 day time period. Which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 27, 2025

Plan of correction: Administrator will refund the resident representive. Administrator will have admission agreement reviewed.

Type of visit: Required - 1 Year

On 08/27/2025 at 1:30pm Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator, Angelina Skevig (cert #7008633740 exp.12-12-25) and explained the purpose of the visit. Administrator certificate is current. LPA Benson and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to five (5) resident rooms, common areas, four (4) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. Medications were also reviewed. Medication is locked in a locked closet. The common area was clean, odor-free and in good repair. All bedrooms had required furniture, bedding, lighting and windows with screens. The bathrooms were clean and in good repair. The kitchen was clean and in good repair. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. All required postings are displayed within the facility. No pools/bodies of water are on the premises. No firearms are on premises. The last disaster drill was conducted and documented on 12-6-24. The following deficiencies were observed (See LIC 809D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted, a copy of the report, and appeal rights provided to administrator.the state’s words, verbatim · CDSS document, Aug 27, 2025

Type of visit: Required - 1 Year

On August 5, 2024 at approximately 10:30 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Bonhurst Assisted Living Corp (House II) for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Caregiver, Maria Wolf and was granted access into the facility. Administrator arrived 5 minutes later. LPA and the Administrator toured the facility. LPA observed the facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on March 2024 at the time of the inspection. All smoke detectors and carbon monoxide detectors were tested with the exception of one room that did not have a smoke detector. Administrator reported that it will be purchased today and installed (See LIC 9102-Technical Violation). LPA educated the Administrator on the importance of ensuring that smoke detectors are operable and in working order at all times. Water temperature in residents bathrooms measured at 106 degrees, within acceptable range of 105 to 120 degrees F. LPA observed sufficient perishable and non-perishable foods located in the kitchen. There are special provisions made for individuals with special dietary needs. Food menu was presently available for viewing during the inspection. Medications were centrally stored and locked. Cleaning products and other toxins are located in the laundry room that was locked and inaccessible to residents in care. There was a supply of linens, cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms in resident’s rooms have a towel and soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of all residents bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms of COVID-19 or other infectious diseases are present in the facility. (Report continued on LIC 9099C) First Aid kit was inspected and found to be appropriate during the inspection. Administrator disclosed that the Infection Control Plan is currently being updated (See LIC 9102-Technical Assistance) LPA reviewed the Emergency Disaster Plan and found that document to be appropriate during the inspection. Emergency Generator was purchased and currently awaiting to be installed. LPA reviewed 5 of 5 resident files and found those files to be appropriate during the inspection. LPA educated the Administrator regarding the importance of ensuring that ALL staff are trained annually as per Title 22 regulations (See LIC 9102-Technical Assistance). LPA observed a new caregiver that just got hired on August 5, 2024 and has not been trained (See LIC 9102-Technical Assistance). LPA educated the Administrator regarding this regulation. LPA reviewed 3 of 3 staff files and found those to be appropriate during the review. 1 of 2 staff members have a valid First AId/CPR (See LIC-9102-Technical Violation). Administrator provided proof that the other staff member is enrolled in First Aid/CPR training. LPA requested the following documents to be sent: LIC 500- Personnel Report LIC 308- Designation of Facility Responsibility LIC 309- Administrative Organization Updated Infection Control Plan Most up-to-date Liability insurance Control of Property Register of residents No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator due to printer issues.the state’s words, verbatim · CDSS document, Aug 5, 2024