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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002715
Report Date: 08/18/2026
Date Signed: 08/18/2026 10:15:07 AM

Substantiated


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
06/24/2026 and conducted by Evaluator Marisa Chiarelli
COMPLAINT CONTROL NUMBER: 59-AS-20260624133439
FACILITY NAME:BONHURST ASSISTED LIVING. CORP (HOUSE II)FACILITY NUMBER:
455002715
ADMINISTRATOR:SKEVIG,ANGELINA MANDRIAFACILITY TYPE:
740
ADDRESS:5957 BEAUMONT COURTTELEPHONE:
(530) 243-3874
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:6CENSUS: 6DATE:
08/18/2026
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Administrator Angelina SkevigTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Staff are mismanaging residents' medications
Staff are not providing incontinence care to residents in need
INVESTIGATION FINDINGS:
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On 08/18/2026 licensing program analyst (LPA) Marisa Chiarelli arrived at the facility unannounced to deliver final complaint findings. LPA Chiarelli met with administrator Angelina Skevig and explained the purpose of the visit.

Allegation: Staff are mismanaging resident’s medications
Findings Substantiated
While investigating the allegation “staff are mismanaging resident’s medications” LPA Chiarelli and administrator Skevig conducted a medication review on residents one (R1) medication. In the medication review LPA Chiarelli found several inconsistencies in the MAR used by the facility when the LPA Chiarelli asked the administrator why the facility had not properly filled out the MAR the administrator stated, “I have been to busy.”
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Marisa Chiarelli
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026
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 3
Control Number 59-AS-20260624133439
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 II)
FACILITY NUMBER: 455002715
VISIT DATE: 08/18/2026
NARRATIVE
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Allegation: Staff are not providing incontinence care to residents in need

Findings Substantiated

While investigating the allegation “staff are not providing incontinence care to residents in need” LPA Chiarelli interviewed three (3) persons and reviewed documentation.

During one interview it was stated that “nurses who came into the facility have found patients soiled.”

In another interview the interviewee stated “that R1 may be incontinent but the facility does not have R1 wear depends just a pad on the bed for leakage.”

Based on investigation observations, record review(s) and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegations is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Appeal rights were explained and provided to the facility

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Marisa Chiarelli
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20260624133439
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 II)
FACILITY NUMBER: 455002715
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care....(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(4) The licensee shall assist residents with self-administered medications as needed.
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Licensee will conduct a MAR and medication training with all staff.
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The licensee did not comply with the section cited above as evidenced by: Record review, interviews and observation. The staff did not give the resident their medication as prescribed per the physician orders, which poses a health, safety or personal rights risks to residents in care.
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Type B
09/15/2026
Section Cited
CCR
87625(b)(3)
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87625(b)(3) Managed Incontinence
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:
(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.
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Licensee will conduct an incontinence care training with all staff.
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The licensee did not comply with the section cited above as evidenced by: Observation and interviews. Several residents incontinence needs were not being taken care which poses a potential health, safety or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Marisa Chiarelli
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3