Haave House

Type of visit: Required - 1 Year

At 12:30 p.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. At approximately 12:50 p.m. Licensee Bonnie Haave arrived and was informed of the reason for the visit. At 01:00 p.m. the LPA conducted a tour of the physical plant with the Licensee to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of six (6) resident bedrooms, one (1) live-in staff room, and two (2) restrooms. The LPA observed one (1) fire extinguishers which was fully charged and last serviced 03/17/2025. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the kitchen. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Kitchen: During the facility tour. the kitchen appeared clean and the appliances and fixtures functional. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Sharps are stored in a locked drawer. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: The LPA observed all bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. Water temperature in resident’s restroom was measured at 105 degrees Fahrenheit. Report will continue on LIC809-C. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. The facility maintained a comfortable temperature of 74 degrees. There were no obstructions and/or tripping hazards throughout the facility. Cleaning supplies and disinfectants are kept in a locked closet in the hallway between the kitchen and bedrooms along with the washer and dryer. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. Interviews: The LPA conducted one (1) resident interview. No concerns were voiced. Record Review: At 01:15 p.m. a review of facility files was initiated. The LPA reviewed five (5) out of six (6) resident files. The following was observed: Resident 1 did not have a Consent for Emergency Medical Treatment on file or their Admission Agreement on file. Upon observation the Licensee stated that they believe R1's family member has the admission agreement and would request it. Resident 2-5 did not have an updated Appraisal/Needs and Services Plan (LIC625) on file, all their LIC 625 were from 2023. At approximately 3:15 p.m. the Licensee had to leave and designated staff Maria Dye to review and sign the report. Due to time constraints the LPA will return at a later date to complete the annual. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided,the state’s words, verbatim · CDSS document, Dec 3, 2025

Allegation investigated: Staff are not providing adequate food service to residents Staff left resident in soiled diapers for extended periods of time Staff are not responding to residents' call buttons in a timely manner Staff made inappropriate comment towards resident Staff are not communicating with resident's authorized repsresntative regarding resident

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit. LPA met with administrator Bonnie Haave and explained the reason for the visit. On 9/11/2025, LPA interviewed a resident, witness, and administrator. LPA conducted a facility tour and inspected the food supply. LPA reviewed and obtained pertinent documents. On 4/29/2025, LPA interviewed another witness over the phone. During today's visit on 4/30/2025, LPA interviewed a witness at 11:14 a.m., staff at 11:04 a.m., and the administrator at 10:00 a.m. LPA reviewed and obtained pertinent documents at 10:30 a.m. (continued on 9099-C) Unsubstantiated (continued from LIC9099; page 1) Regarding the allegation staff are not providing adequate food service to residents: LPA observed a sufficient food supply. LPA asked residents about food service and they responded "good" and "it's delicious". The administrator showed LPA slips of paper Resident 1 (R1) would write their requests for what they wished to be served and staff would accommodate R1's requests. LPA interviewed witnesses who stated staff were very accommodating to R1's wishes, although R1 frequently complained about what they were served, even though it was what R1 requested. Based on interviews and the food supply inspection, this allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation staff left resident in soiled diapers for extended periods of time: LPA interviewed witnesses who observed and provided care to R1. They stated they had not observed R1 with soiled diapers when they visited R1. In addition, they had not observed any skin breakdown which would be indicative of being left in soiled diapers. Based on these interviews, this allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation staff are not responding to residents' call buttons in a timely manner: LPA interviewed a resident who stated they would hear R1 ring their bell/call button and staff would respond right away. Witnesses stated they observed the same. Staff stated when R1 rang they checked on R1 right away. They would also check on R1 regularly without the bell but if R1 didn't ring, or accidentally rang, R1 would get irritated with them and yell and sometimes strike staff. Based on these interviews, this allegation is deemed UNSUBSTANTIATED at this time. (continued on LIC9099-C; page 3) (continued from LIC9099; page 2) Regarding the allegation staff made inappropriate comment towards resident: LPA interviewed a resident and witnesses about how staff communicated with R1. The resident and witnesses stated staff were always kind and respectful to R1, even when R1 was yelling at them. Staff stated they were kind and patient to R1. If R1 was being too aggressive toward them they would leave her alone to let her calm down as she would threaten to strike them with the TV remote or possibly a flashlight. These threats would be due to staff coming into R1's room to check on them without R1 pressing the call button. Staff regularly check on residents to see if they need assistance with incontinence care or if the want a snack or something to drink. Based on this information, this allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation staff are not communicating with resident's authorized representative regarding R1: LPA reviewed text messages sent to the administrator regarding R1 from R1's family. Many of the text messages were sent to the administrator after her normal business hours. The administrator informed the family of her normal business hours of 11:00 a.m. to 4:00 p.m. Most of the text messages were sent outside of those hours and were non emergent. The text messages were responded to later or they were followed up with a phone call. Based on this information, this allegation is deemed UNSUBSTANTIATED at this time. No deficiencies observed. Exit interview conducted and copy of the report issued.the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 29-AS-20240906101058

Type of visit: Required - 1 Year

At 8:30am on 12/16/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual facility inspection. LPA met with Licensee/Administrator, Bonnie Haave, announced who he is and the reason for the visit. This facility has 7 bedroom, 6 of the rooms are single resident occupancy, and the 7th bedroom is a live-in staff bedroom. Facility bedrooms were properly equipped per regulations including additional linins. There are two bathrooms that are shared bathrooms. Bathrooms were stocked with liquid soap and paper towels. The main entrances is in the front of the facility and there is a side entrance. There are two hallways in the facility, one adjacent to the main entrance and one that leads from the living room, medications are stored and locked in a cabinet in the facility hallway leading from the living room. There are tables with umbrellas in the back of the facility and there is a covered side porch with seating for activities and visitors for residents and visitor. There a is a living room, dining room and kitchen at the front of the facility. LPA observed at least 2 days of perishable foods and at least 7 days of non perishable foods for 6 residents and staff. LPA noted that there is a fire extinguisher mounted in the kitchen area that is primed in the green. LPA noted that there are functioning smoke detectors in each resident room. LPA noted that there is a working carbon monoxide detector located in the facility hallway next to the air vent. LPA observed required facility posting in the facility hallway near the main entrance. LPA conducted a sample medication audit, reviewed staff, and resident files. LPA reviewed Emergency Disaster (LIC610) and Infection Control Plans (LIC9282) with Administrator and singed for annual review. LPA and Administrator conducted a full review of the annual control tools modules. LPA noted that there were no citations or violations issued as a result of the facilities annual physical inspection and the annual control tools modules. LPA conducted 2 staff and 4 client interviews. Exit interview, report read and report provided.the state’s words, verbatim · CDSS document, Dec 16, 2024

Type of visit: Required - 1 Year

At 09:05 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by Licensee Bonnie Haave and informed them of the reason for the visit. Record Review: At 09:15 a.m. a review of facility files was initiated. The LPA reviewed five (5) out of six (6) resident files. The LPA reviewed five (5) out of five (5) staff files. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill (conducted on 10/10/2023). The LPA obtained a Client Roster and Staff Roster. All documents reviewed appeared complete and current. Interviews: At 12:30 p.m. the LPA conducted two (2) staff and two (2) resident Interviews. No immediate concerns were voiced. Medications: At 1:00 p.m. a medications review was initiated. Medications are centrally stored and locked in a hallway closet; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record, however, start dates for several medications of all residents were not documented. A conversation was held between the LPA and Licensee Bonnie of the importance of best practice in writing a start date for all medications. Licensee Bonnie stated that moving forward, the start date for all medications will be documented. At 02:40 p.m. the LPA conducted a tour of the physical plant with Licensee Bonnie Haave to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of six (6) resident bedrooms, one (1) staff room, and two (2) restrooms. The LPA observed one (1) fire extinguishers which was fully charged and last serviced 01/02/2023. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the kitchen. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Report will continue on LIC809-C. Kitchen: During the facility tour at 02:40 p.m. the kitchen appeared clean and the appliances and fixtures functional. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Sharps are stored in a locked drawer. At 2:42 p.m. the LPA observed a steak knife unattended in the kitchen accessible to residents in care. Upon observation, staff locked the knife away. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. At 2:44 p.m. the LPA observed staff room unlocked with medication accessible to residents in care. Upon observation, staff locked the staff room. Bathrooms: The LPA observed all bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. At 2:53 p.m. water temperature in resident’s restroom was measured at 106.4 degrees Fahrenheit. The hot water measured was within the required limit of 105-120 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. The facility maintained a comfortable temperature of 74 degrees. There were no obstructions and/or tripping hazards throughout the facility. Cleaning supplies and disinfectants are kept in a locked closet in the hallway between the kitchen and bedrooms along with the washer and dryer. The garage: The LPA observed the garage, where the emergency food and water is stored. The garage is locked. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. Infection Control: The home has an adequate supply of Personal Protection Equipment (PPE) and can obtain additional supplies. The home’s policies and procedures pertaining to infection control were adequate. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to Licensee Bonnie Haave.the state’s words, verbatim · CDSS document, Dec 1, 2023