Bonhurst Assisted Living. Corp. (House I)

Type of visit: Required - 1 Year

On 9/25/2025 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 Mandria 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 six (6) resident rooms, common areas, five (5) 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. There is a schedule of activities planned for the clients. 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 8-30-25, the facility has been conducting drills every 3 months. LPA interviewed one resident and one staff. The facility is in compliance. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report was provided to administrator.the state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Case Management - Incident

On 7-17-25 Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to conduct a case management visit. LPA met with Administrator Angelina Mandria Skevig and explained the reason for the visit. Department followed up on Incident Report (IR) sent by facility on 06-23-25 stating that resident, R1 had a hip fracture which was diagnosed on 06/21/25. Staff reported hearing a noise inside the bathroom on 6-21-25 at 4:30am. Staff opened the door and found R1 lying on left side on the floor. R1 said their left knee gave out and they fell. Staff reported a penny size skin tear was peeling on elbow and complaining of pain in left hip. Staff reported sending R1 to the hospital. R1 doctor ordered lab work and X-RAY with results of hip fracture. Department conducted interviews with the administrator regarding this incident. At this time, this case is under review and department will do follow up as needed. No citations were issued per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, Jul 17, 2025

Type of visit: Required - 1 Year

On August 21, 2024 at approximately 08:15 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Bonhurst Assisted Living Corp (House I) for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Caregiver, Rosario Mandria and was granted access into the facility. Administrator arrived 15 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 and found to be operational at the time of the inspection. Water temperature in residents bathrooms measured at 109 degrees in 2 of 2 residents bathrooms and is within acceptable range of 105 to 120 degrees F. LPA observed sufficient perishable and non-perishable foods located in the kitchen and the garage refrigerator. 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. Medication orders for residents in care were reviewed and found to be appropriate during the inspection. First Aid Kit was inspected and found to be appropriate during the inspection. 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. Emergency Disaster Plan is currently being updated (See LIC 9102-Technical Advisory). (Report continued on LIC 809C) LPA reviewed staff files and found those files to be appropriate. LPA reviewed resident records and found those to be appropriate during the inspection. LPA requested the following documents to be sent: LIC 500- Personnel Report LIC 308- Designation of Facility Responsibility LIC 309- Administrative Organization Updated Emergency Disaster Plan Most up-to-date Liability insurance Control of Property Register of residents LPA advised Facility Administrator to conduct a staff refresher course on Title 22 regulation-87211-Reporting Requirements (See LIC 9102-Technical Advisory). LPA also provided Technical Assistance on this matter and the importance of reporting incidents to Community Care Licensing. LPA educated the Administrator on contacting the Officer of the Day line and/or the LPA assigned to the facility if there are any questions. No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this signed report was printed and given to the Administrator.the state’s words, verbatim · CDSS document, Aug 21, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff did not return residents wedding ring to authorized representative after residents’ death.

/072024 Licensing Program Analyst (LPA) Jaynae Boyles made an unannounced visit to the facility and met with the Administrator. The purpose of this visit is to deliver the results of a complaint investigation. During the interview process, the administrator was interviewed. During the review of records, LPA reviewed the files of one resident (R1), including, admissions agreement, preplacement appraisal, admissions policies, refund policies, house rules, hospice admissions and payment history. Unfounded LPA investigated the allegation, “Staff did not return residents wedding ring to authorized representative after residents’ death”. The Administrator reported to the LPA that the wedding ring is still in the facility, stored in the safe. The administrator reported that they have contacted R1 responsible party on several occasions for pick up of the residents’ personal items with no avail. According to the admissions agreement, theft and loss policy was signed by R1 indicated that in the event of a death of a resident the facility will safeguard all personal belongings until turned over to the resident’s family. The administrator is adhering to the facility policy signed by R1 and ensuing the safeguard of these items until the responsible party can pick up R1 items. This agency has investigated the complaint alleging,” Staff did not return residents wedding ring to authorized representative after residents’ death”. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. LPA was able to determine R1 passed in October 2022 and no refund was issued. In addition, Health and Safety Code §1569.652 states facilities are required to refund responsible party within 15 days of the death of a resident and once their personal belongings have been removed. LPA was able to determine that the personal belongings of the resident have not been returned. Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. An exit interview was conducted. A copy of the report was provided to the administrator.the state’s words, verbatim · CDSS document, Mar 7, 2024 · control 59-AS-20240125145955

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(C) · Plan of correction due date: Mar 14, 2024

Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds. (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. Based on record review facility did not refund R1's responsible party withing 15 days which poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Administrator agrees to meet with R1's responsible party to review refund amount. Once meeting has taken place Administrator to send LPA the refund amount given to R1's responsible party.

Allegation investigated: Staff did not properly clean a resident resulting in a Urinary Tract Infection (UTI). Staff left a resident in soiled diapers. Staff did not shower a resident.

On 11/06/23 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 08/14/23. LPA Gurriere met with Angelina Skevig, Administrator, and explained the purpose of the visit. Staff did not properly clean a resident resulting in a Urinary Tract Infection (UTI). During the interview process, the Administrator, three staff persons and the resident’s family member were interviewed. The resident (Resident 1) was not interviewed, as she has since moved from the facility. Documents were received and reviewed to include the Physician’s Report, Admission Agreement, resident medications list and staffing list. continued Unsubstantiated continued During the investigation, it was reported by several staff persons that within a few days of being at the facility, the resident notified the administrator via text that she thought that she had a UTI due to pain. It was stated that the administrator immediately notified the nurse practitioner, and the nurse practitioner ordered an antibiotic for the resident’s UTI. Staff left a resident in soiled diapers. During the interview process, the Administrator, three staff persons and the resident’s family member were interviewed. The resident (Resident 1) was not interviewed, as she has since moved from the facility. During the investigation, it was reported by staff that the resident could advise the staff if she needed to be changed or toileted and that staff would change the resident as needed. It was further reported that staff were continually with the resident and would check on her changing needs at least every two hours. Staff did not shower a resident. During the interview process, the Administrator, three staff persons and the resident’s family member were interviewed. The resident (Resident 1) was not interviewed, as she has since moved from the facility. During the investigation, it was reported by staff that staff gave the resident a shower three times in 11 days, as the resident was only at the facility for a short time. In addition, it was reported that the staff would give the resident a bed bath in between the resident’s shower days. Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are Unsubstantiated.the state’s words, verbatim · CDSS document, Nov 6, 2023 · control 59-AS-20230814132715