Holy Haven II

Type of visit: Required - 1 Year

At approximately 12:45 PM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year inspection and was greeted by caregiver Demetrio Salva who has Designation of Facility Responsibility (RP). RP called licensee Leslie Ann Pascua to advise of today's inspection. Licensee arrived at approximatly 01:15 PM to further assist with today's required inspection. During today's inspection, a resident that would normally be away at a day program is home after a private appointment with the licensee. Facility was vendorized with North Bay Regional Center (NBRC) in June of 2025 and currently the facility has one (1) resident in care. Licensee indicates that NBRC plans to only send them 4 residents and they may look to convert one or two bedrooms to staff room on their facility sketch. Currently fire clearance has been approved for five (5) non-ambulatory residents. Facility has a waiver for three (3) residents receiving hospice services. Facility has a dementia plan on file with Community Care Licensing (CCL). At approximately 1:00 PM, LPA initiated a tour of the facility and observed the following: Facility is a one story home with auditory signals activated on all exits, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured at approximately 109 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed 4 of 4 bathrooms had required anti-slip mats and grab bars. LPA observed a supply of incontinent care products and paper products available to residents. LPA observed adequate supply of towels, bedding sheets, and hygiene products. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Continued on LIC809-C... Continued from LIC809... Facility has at least two days of perishable foods, and at least one week of non-perishable foods or emergency water. LPA observed a sample menu posted in the common area to indicate a healthy and balanced set of meals for residents in care. Licensee was reminded of the importance of maintaining the nutritive value of foods including labeling leftovers like meat with the date the are removed from commercial packaging and placed into airtight items like ziplock bags and tupperware. The facility has both internet service and operating phone. Facility has a designated area with locked cabinets for centrally stored medications and resident, staff, and facility files. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, and games available for resident use. Facility has one fire extinguisher, which was observed to be fully charged and last inspected on 07/2026. Smoke and Carbon Monoxide detectors were tested and operational during inspection, facility has hardwired units that are backed up with 9V batteries encase of power outage and one detector was chirping and licensee replaced that back-up battery during the inspection. The backyard features paved walkways and a patio with shaded seating for resident outdoor use. In addition property has a number of overgrown fruit trees with dropping fruit and bushes that could present a potential slip/trip hazard, as well as, increased fire risk and licensee was advised to aggressively cut-back trees and bushes and remove fallen fruit on the ground and maintain the patio free from tripping hazards. Licensee is considering a move to another property and was advised to follow up with licensing to ensure proper steps for move is made. At approximately 1:30 PM Three (3) of 3 staff files were reviewed and all had required documentation per title 22 regulations. At approximately 2:00 PM one (1) of 1 Resident file was reviewed and all required documentation was present. At approximately 2:30 PM LPA observed P&I monies to be centrally stored and accounted for. Continued on LIC809C Continued from LIC 809-C At approximately 2:40 PM LPA observed medicines to be centrally stored and the Medication Administration Record (MAR) to be accurate. LPA obtained updated copies of updated LIC 400 (Affidavit of Client Cash Resources), Evidence of valid liability insurance and updated LIC 9020 Register of Facility Clients/Residents. Licensee called their insurance agent to increase their Surety Bond to match their update LIC400. Licensee is ask to submit both a new LIC 500 Personnel Roster and updated Surety Bond to match newest LIC 400 by 08/26/2026 No deficiencies are cited today. This report was reviewed with Licensee whose signature here confirms receipt.the state’s words, verbatim · CDSS document, Jul 27, 2026

Type of visit: Required - 1 Year

At approximately 9:35 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year inspection and was greeted by Licensee Leslie Ann Enriquez. The facility was recently vendorized with North Bay Regional Center (NBRC) in June of 2025 and currently the facility has no residents in care. Licensee indicates that NBRC plans to only send them 4 residents and they may look to convert one or two bedrooms to staff room on their facility sketch. Currently fire clearance has been approved for five (5) non-ambulatory residents. Facility has a waiver for three (3) residents receiving hospice services. Facility now has a dementia plan on file with Community Care Licensing (CCL). At approximately 9:50 AM, LPA initiated a tour of the facility and observed the following: Facility is a one story home with auditory signals activated on all exits, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured at approximately 108 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed 4 of 4 bathrooms had required anti-slip mats and grab bars. LPA observed a supply of incontinent care products and paper products available to residents. LPA observed adequate supply of towels, bedding sheets, and hygiene products. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. There is a sufficient amount of dishes and cooking supplies for resident use with sharps and other hazardous items kept secured in various designated drawers and cabinets as well as under the kitchen sink. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable foods, and at least one week of non-perishable foods or emergency water. LPA observed a sample menu posted in the common area to indicate a healthy and balanced set of meals for residents in care. Continued on LIC809-C... continued from LIC809... The facility has both internet service and operating phone and a new phone number that will be updated for the facility. Facility has a designated area with locked cabinets for centrally stored medications and resident, staff, and facility files. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, and games available for resident use. LPA obtained a newly developed sample activity schedule for residents. Facility has one fire extinguisher, which was observed to be fully charged and last inspected on 03/2025. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Licensee has posted hard copies of the required emergency disaster plan and maps, admissions agreement, theft and loss program, personal rights information, and reporting posters in facility communal areas. The facility Emergency and Disaster Plan for Residential Care Faculties for the Elderly (LIC610E) was updated during inspection on 07/31/2025 including new facility phone number. LPA informed Licensee that visiting hours shall be posted as well one residents are in care. Licensee is aware of the association and staff transfer process.The backyard features paved walkways and a patio with shaded seating for resident outdoor use. In addition property has a number of overgrown fruit trees with dropping fruit and bushes that could present a potential slip/trip hazard, as well as, increased fire risk and licensee was advised to aggressively cut-back trees and bushes and remove fallen fruit on the ground and maintain the patio free from tripping hazards. At approximately 10:50 AM two(2) of 2 staff files were reviewed and one (1) of (2) not have evidence of required 40 hours of initial/required training, however no residents are in care and licensee was given information on educational requirements for those that administer medicines and general caregivers at an RCFE, including the need for 20 hours of annual documented training with emphasis on dementia, postural supports and prohibited conditions. LPA obtained updated copies of LIC610E, Liability Insurance (valid until 04/2026), and activity schudule. Licensee is ask to submit both a new LIC500 and LIC9020 ONCE they receive their first resident in care. No deficiencies are cited today. Technical Advisories are issued from the California Code of Regulations (CCRs), and/or the Health and Safety Code. This report was reviewed with Licensee.the state’s words, verbatim · CDSS document, Jul 31, 2025

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

At approximately 1:45 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a pre-licensing inspection and was greeted by Licensee Applicant, Leslieann Enriquez. This pre-licensing inspection is being conducted for an initial licensing of a Residential Care Facility for the Elderly (RCFE). Fire Clearance has been approved for five (5) non-ambulatory residents. Facility has a waiver for three (3) residents receiving Hospice services. Facility has submitted a dementia plan to CCL as well. Licensee Applicant is currently in partnership with North Bay Regional Center (NBRC) and plans for resident placement upon issuance of license. At approximately 2:00 PM, LPA initiated a tour of the facility and observed the following: Facility is a one story home with auditory signals activated on all exits, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured at approximately 135 degrees F, which is above the allowable range of 105 to 120 degrees F per Title 22 regulations. Licensee Applicant lowered the water heater temperature two separate times during inspection and the water temperature did not change. LPA observed resident showers with the required non-slip mats, but 1 of 4 bathrooms was missing the required grab bars. Licensee Applicant agreed to install some. LPA observed a supply of incontinent care products and paper products available to residents. LPA informed Licensee Applicant of the need to increase the facility's supply of towels, bedding sheets, and hygiene products. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. There is a sufficient amount of dishes and cooking supplies for resident use with sharps and other hazardous items kept secured in various designated drawers and cabinets as well as under the kitchen sink. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable foods, but does not have at least one week of non-perishable foods or emergency water. LPA observed a sample menu posted in the common area to indicate a healthy and balanced set of meals for residents in care. Continued on LIC809-C... continued from LIC809... The facility has internet service but does not currently have telephone service or an internet access device for resident use. Licensee Applicant agreed to obtain a designated phone and phone service for the facility as well as an internet access device for resident use. Facility has a designated area with locked cabinets for centrally stored medications and resident, staff, and facility files. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, and games available for resident use. LPA informed Licensee Applicant that the facility shall increase it's PPE supply and post an activity schedule for residents viewing. Facility has one fire extinguisher, which was purchased in January 2024 and is fully charged. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Licensee Applicant has posted hard copies of the required emergency disaster plan and maps, admissions agreement, theft and loss program, personal rights information, and reporting posters in facility communal areas. LPA informed Licensee Applicant that visiting hours shall be posted as well. Licensee Applicant will begin hiring additional staff once license approved and NBRC approves the facility's vendor application. Licensee is aware of the association and staff transfer process. Licensee Applicant provided LPA with a copy of the facility's lease agreement, affidavit regarding client resources, and surety bond. Licensee Applicant to submit proof of liability insurance. The backyard features paved walkways and a patio with shaded seating for resident outdoor use. Windows and blinds are all found to be in good repair and facility exits are clearly identified. LPA observed bedroom #4 missing a window screen and bedroom #3 requiring a new one. LPA informed Licensee Applicant of the need to remedy this before the follow-up pre-licensing visit, which will be scheduled at a later date. Component III orientation was conducted with the Licensee Applicant at facility. Licensee/Applicant conveyed knowledge and understanding of Title 22 regulations. Today's pre-licensing evaluation has been completed, and a follow up visit is needed to verify all identified deficiencies are remedied. Applicant to submit proof of correction (POC) for each technical assistance issued today via form LIC9102 before LPA will schedule follow up inspection. Exit interview conducted with Licensee, whose signature on this document confirms receipt.the state’s words, verbatim · CDSS document, Jul 18, 2024

The state marks this report as 11 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 5 Census (if any clients in care): none COMP II Participants: Leslie Ann Enriquez, Applicant/Administrator Interview Method: Telephone interview On June 25, 2024, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicant/Administrator. Copy of report sent via email and request to return sign copy to CAB by end of business day today.the state’s words, verbatim · CDSS document, Jun 25, 2024