306004509-11-7-2023-22-AS-SSAS-CZUNSA-20240126094250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004509
Report Date: 11/07/2023
Date Signed: 11/07/2023 12:18:21 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/17/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231017103145

FACILITY NAME:	BONAFIDE HOME CARE		FACILITY NUMBER:	306004509
ADMINISTRATOR:	ERLEEN B. RINEHART		FACILITY TYPE:	740
ADDRESS:	25215 ROMERA PL.		TELEPHONE:	(949) 716-4914
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	6	CENSUS: 5	DATE:	11/07/2023
		UNANNOUNCED	TIME BEGAN:	08:43 AM
MET WITH:	Facility Administrator - Erleen Rinehart		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff neglect led to resident suffering from a UTI
Staff neglect led to resident suffering a severe bowel impaction
Facility retained a resident with a higher level of care needs
Staff did not report incident involving resident to their representative
Staff did not seek medical attention for resident in a timely manner

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted, and granted entry by facility administrator (AD) Erleen Rinehart.

It was alleged that staff neglect led to resident suffering from a UTI. 5 interviews conducted with residents did not corroborate with the allegation by stating that the facility "always" assists each resident with tolieting needs and will give each resident fluids as a preventative measure from getting urinary infections. 2 interviews conducted with staff stated that the resident (R1) had a history of UTI, and had a UTI prior to admission into the facility. Per document review, it was observed that the facility contacted the hospice agency to obtain medical attention and antibiotics for R1 upon being diagnosed with a UTI.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/17/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231017103145

FACILITY NAME:	BONAFIDE HOME CARE		FACILITY NUMBER:	306004509
ADMINISTRATOR:	ERLEEN B. RINEHART		FACILITY TYPE:	740
ADDRESS:	25215 ROMERA PL.		TELEPHONE:	(949) 716-4914
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	6	CENSUS: 5	DATE:	11/07/2023
		UNANNOUNCED	TIME BEGAN:	08:43 AM
MET WITH:	Facility Administrator - Erleen Rinehart		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are unable to communicate with resident about their needs due to language barrier

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted, and granted entry by facility administrator (AD) Erleen Rinehart.

It was alleged that staff are unable to communicate with resident about their needs due to language barrier. LPA conducted a total of 5 resident interviews, of which all 5 did not corroborate with the allegation by stating that communication with staff are "never" an issue and that staff are able to easily communicate with each resident about their needs. All 5 resident interviews also specified that staff are "friendly" "caring" and "attentive", and verified that there were no barriers regarding communication amongst staff and residents.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, this allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with AD Rinehart. A copy of this report was provided and explained.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 22-AS-20231017103145

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BONAFIDE HOME CARE	FACILITY NUMBER: 306004509
	VISIT DATE: 11/07/2023

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

It was alleged that staff neglect led to resident suffering a serve bowl impaction. 5 interviews conducted with residents did not corroborate with the allegation by stating that staff are "attentive" and "patient" whenever a resident uses the restroom, and denied of staff neglect. Per document review, it was observed that the facility contacted hospice services to obtain medication to assist with R1's bowel impaction. Per document review, it was also observed that the facility completes a bathroom log and noted every time a resident uses the bathroom.

It was alleged that facility retained a resident with a higher level of care needs. LPA conducted a total of 7 interviews which consisted of residents and staff, who all stated that prior to admission into the facility, each resident will have an intake assessment conducted by the facility administrator to determine the needs of each resident. It was also stated and observed that each resident undergoes a medical evaluation conducted by a physician to determine the level of care each resident needs.

It was alleged that staff did not report incident involving resident to their representative. LPA conducted a total of 7 interviews which consisted of staff and residents. 5 resident interviews verified that the staff regularly communicates with their families to update them about the resident's status, along with any concerns. 2 interviews conducted with staff stated that the AD is the staff member who contacts the residents family via phone call, or in person if there were any incidents regarding the resident and care provided. LPA reviewed incident reports that the facility has completed, and observed that each incident report indicated that the resident's family was notified.

It was alleged that staff did not seek medical attention for resident in a timely manner. LPA conducted a total of 7 interviews which consisted of staff and residents. The 7 interviews conducted did not corroborate with the allegation by stating that the staff does medical attention through consulting, communicating and coordinating with the resident's medical team and contacts the applicable individuals such as hospice, and paramedics if needed.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20231017103145

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BONAFIDE HOME CARE	FACILITY NUMBER: 306004509
	VISIT DATE: 11/07/2023

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

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted with AD Rinehart. A copy of this report was explained and provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4