455002715-8-5-2024-59-AS-FSAI-D7URQ2-20240805131248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455002715
Report Date: 08/05/2024
Date Signed: 08/05/2024 01:13:31 PM

Document Has Been Signed on 08/05/2024 01:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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 II)		FACILITY NUMBER:	455002715
ADMINISTRATOR:	SKEVIG,ANGELINA MANDRIA		FACILITY TYPE:	740
ADDRESS:	5957 BEAUMONT COURT		TELEPHONE:	(530) 244-8458
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	6	CENSUS: 5	DATE:	08/05/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Caregiver, Maria Wolf Administrator, Angelina Mandria Skevig		TIME COMPLETED:	01:30 PM

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	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)

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 II)	FACILITY NUMBER: 455002715
	VISIT DATE: 08/05/2024

NARRATIVE

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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.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024

LIC809 (FAS) - (06/04)

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