455002714-11-7-2023-59-AS-KHOS-CY3MDQ-20231130083131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002714
Report Date: 11/06/2023
Date Signed: 11/07/2023 08:54:55 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2023 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20230814132715

FACILITY NAME:	BONHURST ASSISTED LIVING. CORP (HOUSE I)		FACILITY NUMBER:	455002714
ADMINISTRATOR:	SKEVIG, ANGELINA MANDRIA		FACILITY TYPE:	740
ADDRESS:	1306 BONHURST DRIVE		TELEPHONE:	(530) 244-8458
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	6	CENSUS: 5	DATE:	11/06/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	ANGELINA SKEVIG		TIME COMPLETED:	09:10 AM

ALLEGATION(S):

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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.

INVESTIGATION FINDINGS:

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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

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
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)

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Control Number 59-AS-20230814132715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BONHURST ASSISTED LIVING. CORP (HOUSE I)	FACILITY NUMBER: 455002714
	VISIT DATE: 11/06/2023

NARRATIVE

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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.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
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)

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