Holy Spirit Residential Care Home-III

Type of visit: Required - 1 Year

At approximately 9:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Perla Gonzalez and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for six residents. At approximately 9:30AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be 66 degrees in the common area. Staff told LPA the thermostat is adjustable but it isn't communicating with the system. Administrator informed LPA they recently had the heating system services and they will contact them again to correct the issue. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. Facility has sprinklers throughout. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required supply of perishable and non-perishable food. Emergency water was present to ensure facility can be self-sufficient for 72 hours. Facility has a generator to supply power in an emergency. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills every 3 months. At approximately 10:00AM, LPA reviewed 5 of 5 resident files. 2 of 5 records did not contain evidence of medical assessment within the last 12 months. One of five records did not contain a signed admission agreement or Pre-Admission Appraisal. Reappraisals were current in 4 of 5 records. Medication records were organized and contained orders for each medication. Medications were secured in a locked cabinet. Continued on LIC809-C… At approximately 11:00AM, LPA reviewed 5 staff files. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current. All employees requiring background checks are cleared. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Evidence of control of Property, (Current Rental/Lease Agreement/Deed) LIC500- Personnel Report LIC610E- Disaster Plan Evidence of Liability Insurance Current Admission Agreement Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Perla Gonzalez and Appeal rights were given.the state’s words, verbatim · CDSS document, Feb 18, 2026

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to continue a Required-1 Year inspection and review staff and resident records. LPA met with Administrator Genaro Gonzalez and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 6 residents. At approximately 8:40AM, LPA reviewed 6 resident files. All resident files contained the required documentation. Reappraisals were conducted within the last 12 months. LPA discussed with Administrator the value of being more detailed when conducting the Reappraisals to ensure person centered care. Documentation of a medical assessment made within the last 12 months or a signed declination were present. At approximately 9:40AM, LPA conducted a review of medications. Medication is locked and not accessible. First aid kit was present. At approximately 9:50AM, LPA reviewed 6 staff files. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current. Facility did not have documentation of a completed emergency drill within the last 3 months. Evidence of Liability insurance received during this visit. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC610E- Disaster Plan Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Genaro Gonzalez and Appeal rights were given.the state’s words, verbatim · CDSS document, Apr 8, 2025

Type of visit: Required - 1 Year

At approximately 1:45PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Caregiver Belen Sedano and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 6 residents. At approximately 1:55PM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen contained cooking/dining equipment that was clean and orderly, utensils were present. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained in an orderly fashion. Facility has required seven-day non-perishable and two-day perishable supply of food. Facility has a generator to supply power in an emergency. Emergency lighting devices were present. Due to time constraints, LPA will return at a later date to review resident and staff records. No citations issued during this visit.the state’s words, verbatim · CDSS document, Mar 25, 2025

Type of visit: Required - 1 Year

At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced annual required inspection of this licensed senior care facility. LPA met with Administrator Perla Gonzalez. At approximately 8:45AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in inaccessible to residents. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were charged. Smoke detectors were found to be in working order. Facility has fire sprinklers throughout. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. At approximately 9:30AM, LPA reviewed 5 of 5 resident records and found 1 of 5 residents did not have a current physician's reports or care plan. 5 of 5 records contained current and signed admission agreements and physician's orders for medications. At approximately 11:00AM, LPA reviewed 6 of 6 staff records. All records contained documentation of completed training as required. Evidence of current first aid and CPR training were current. At approximately 11:30AM, LPA reviewed the facility emergency disaster plan. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducts disaster drills quarterly. No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.the state’s words, verbatim · CDSS document, Mar 21, 2024