Holly Homecare Services

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a single level structure and licensed for six nonambulatory residents. As of today, the facility has three residents, and two were present during the annual inspection. Bedrooms: There’s a total of four bedrooms, of which three bedrooms are for the residents, one bedroom is for staff. All bedroom’s were clean organized and meet regulation guidelines. Bathroom: There’s a total of three bathrooms. Two for residents and one staff bathroom. All bathrooms were clean and organized. Cleaning items are locked under the sinks. Hot water measured in between 109.6 – 110.6 degrees F. Kitchen: Kitchen was clean and organized. Stove is electric with safety features and all burners were operational. Sharps and cleaning items are kept locked in a cabinet below the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed in the kitchen. Resident & Staff Files: Resident and staff files are locked in the medication closet in the main hallway. File Review: 3 of 3 resident files were reviewed during the visit, and four staff files were reviewed. Medications/First-Aid Kit: Client medications are stored in a locked medication closet in the main hallway. Two first aid kits were observed in the locked medication closet. Medication Review: 3 of 3 resident medications were reviewed during the visit. Medication is being administered as prescribed. No discrepancies were noted. Continued on LIC809C Linens & Hygiene Supplies: Hygiene items were observed in a locked hallway closet. Laundry: A laundry room equipped with a washer and dryer was observed. An additional supply of linens was observed in the laundry room. Garage Area: The garage is primarily used as a storage and was observed clean and organized. An emergency supply of water was observed as well as incontinent care supplies. Backyard/Exterior: The backyard is clean and very organized. Walkways are free of obstruction. A table and chairs were observed under a shaded patio area. Bodies of Water: None. Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguisher was observed mounted on a wall in the kitchen. An emergency evacuation drill: Was conducted July 16, 2026. Evacuation drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Several facility postings are posted are available for review on the main postings board in the office area in the living room. Additional Comments: Emergency food and water was observed during the inspection. Facility contact information was reviewed and updated during the visit. No deficiencies are being cited during today’s visit. An exit interview conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 1, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA met with Administrator/ Licensee (AD) Imelda Nuval Lenz. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on May 6, 2025 for a total capacity of six; five non ambulatory and one bedridden in bedroom #4. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms. The hot water temperature measured between 119.5 and 120.0 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational. The three fire extinguishers were charged and purchased on May 1, 2025. The facility has an Emergency Disaster and Infection Control Plan. LPA inspected the kitchen and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. Sharps/knives and cleaning supplies were locked underneath the sink. Emergency water was stored in the garage. All appliances, refrigerator/freezer, dishwasher, washer/dryer and stove are new and in working order. LPA observed the locked medication storage and First Aid Kit. The First Aid Kit had all of the required elements. The PUB 475 "See Something, Say Something" poster was posted in the main entryway; as well as the Long Term Care Ombudsman poster. Emergency Disaster Plan, Theft and Loss, Resident/Family Rights and Grievance Procedures were posted. AD will post visiting hours as well. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured each of the four bedrooms and all had the required furnishings and linens. A fire door separates the common living/dining areas from the bedrooms. Three bedrooms are shared with bedroom #4 allowed for a bedridden resident. The fourth bedroom is a staff room. LPA inspected the exterior and there were no obstacles in pathways. All exterior gates were open and accessible. There is a shaded seating area and plenty of outdoor space for activities. There were board games, pool noodles and word search puzzles in the common living room for activities. Administrator Imelda Nuval Lenz has a current Administrator's Certificate that expires on August 21, 2025. LPA conducted the Component Three Orientation with AD. AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided to Licensee.the state’s words, verbatim · CDSS document, Jul 10, 2025