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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609959
Report Date: 07/28/2023
Date Signed: 10/31/2023 05:41:16 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2023 and conducted by Evaluator Angel Ascencio
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20230721162950
FACILITY NAME:WALNUT GARDEN TOOFACILITY NUMBER:
197609959
ADMINISTRATOR:ILLOUZ, IZHAKFACILITY TYPE:
740
ADDRESS:12805 COLLINS STTELEPHONE:
(818) 509-7989
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:6CENSUS: 7DATE:
07/28/2023
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Izhak Illouz, AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Licensee operating overcapacity
INVESTIGATION FINDINGS:
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******THIS LIC9099 SUPERSEDES AND AMENDS THE LIC9099 REPORT ISSUED ON 07/28/23 AND CORRECTS THE TITLE 22 SECTION NUMBER INCORRECTLY CITED.*****

Licensing Program Analyst (LPA) Angel Ascencio conducted an initail complaint visit to the above facility. LPA Ascencio met with Administrator Izhak Illouz at 10:00 a.m. Entrance interview conducted.

On 07/21/2023, the Department received a complaint alleging that the licensee is operating overcapacitiy. on 07/28/2023, LPA Ascencio conducted a facility tour at 10:10 a.m. During the tour, the LPA observed one (1) resident in the dinning room, 1 resident in the living room, and five (5) residents in their private bedrooms. Upon futher review of the Fire Inspection Report, dated 01/17/2020, the Licensee is licensed only to operate at a capacity of six (6). Administrator Illouz indicated that the other resident/tenant, Individual #1 (I1) lives in the addtional dwellingling unit (ADU) in the back of the property. They are not responsible for
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
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 5
Control Number 29-AS-20230721162950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: WALNUT GARDEN TOO
FACILITY NUMBER: 197609959
VISIT DATE: 07/28/2023
NARRATIVE
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care of this person, but the family pays Licensee to house the tenant in the ADU. The private caregiver called and stated they were running late and our staff assisted the resident this morning. Additionally, moving forward, Administrator Illouz stated they will house the residents and tenants separately. Administrator understood that no care or supervision by the facility should be made available for this additional person if person is only a tenant. That same day, interviews with staff members confirmed that there is an additional person at the home that lives in the ADU. Most days, I1 stays in their room, other times, they come to the home and be part of our facility. Additionally, staff interviews confirmed I1 has a private 24hr caregiver that family is paying for. However, interviews also revealed that family pay for private caregivers at night only while facility staff conduct all activities of daily living (ADL) to the resident during day time hours.

Although Administrator Illouz stated that I1 is a tenant in the ADU, Administrator Illouz admitted that I1 was in the facility and that the facility assisted I1 this morning due to the private caregiver being late. Furthermore, although some staff interviews indicated that staff dont assist with ADL's, additional staff interviews confirmed that I1 is being assisted with all ADL's by facility staff.

The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of
Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in
civil penalties.

An Immediate Civil Penalty Assessment of $500.00 has been issued today 07/28/2023 for Fire Clearance. Civil penalties will be assessed against any facility that fails to take corrective action within described time
periods.

Exit interview conducted. A copy of the report and appeal rights were provided via email to Administrator.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20230721162950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: WALNUT GARDEN TOO
FACILITY NUMBER: 197609959
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/31/2023
Section Cited
CCR
87202(a)
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Fire Clearance: All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by: the licensee accepted
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The Licensee will work with the family of the 7th resident (R1) in relocating the resident to another licensed facility that has vacancies or a location that is more appropriate to meet the needs of the resident, ASAP. The licensee will also provide the Department with a copy of the permits and the
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a 7th resident(R1) that exceeded the maximum capacity approved by the fire clearance granted for 6 non-ambulatory residents. The resident was also placed in a converted alternate dwelling unit located on the premises, that was never fire cleared for use as a bedroom.
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approved Ceritificate of Occupancy for the converted Alternate Dwelling Unit by no later than 11/15/23.

*** Resident #1(R1) was relocated by famiily on 10/19/23****
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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: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2023 and conducted by Evaluator Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20230721162950

FACILITY NAME:WALNUT GARDEN TOOFACILITY NUMBER:
197609959
ADMINISTRATOR:ILLOUZ, IZHAKFACILITY TYPE:
740
ADDRESS:12805 COLLINS STTELEPHONE:
(818) 509-7989
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:6CENSUS: 7DATE:
07/28/2023
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Izhak IllouzTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility is in disrepair (hot water)
Facility has pest
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angel Ascencio conducted an initail complaint visit tot he above facility. LPA Ascencio met with Administrator Izhak Illouz at 10:00 a.m. Entrance interview conducted.

On 07/21/2023, the Department received a complaint alleging that the facility is in disrepair due to not having hot water and that the facility has pest. On 07/28/2023, LPA Ascencio conducted a facility tour at 10:10 a.m. During the tour, the LPA observed four (4) resident private restrooms in which hot water temperature measured 117.0, 116.9,117.0 and 115.5 degrees F. repectively. Additionally, the kitchen hot water measured 116.8 degrees F, while the common hallway bathroom measured 116.0 degrees F. That same day, interview with staff members, beginning at 10:43 a.m., revealed that the hot water can take awhile for it to warm up. This does not happen often as there are days the hot water is available quickly while other times throughout the day, it takes longer to the hot water to warm up.
Continued on LIC 9099 - C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20230721162950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: WALNUT GARDEN TOO
FACILITY NUMBER: 197609959
VISIT DATE: 07/28/2023
NARRATIVE
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Lastly staff interviews stated they do not have a problem when showering residents, as they have to turn on the faucet before to warm up the water.

Although, staff indicated that they have problems with hot water taking too long for it to come out, interviews indicated that they always have hot water available. Temperature readings of all faucets available at the home indicated that hot water is available and within normal range of 120 degree F. Thus, the allegation is deemed unsubstantiated.

Regarding the facility has pest.On 07/28/2023, LPA Ascencio conducted a facility tour at 10:10 a.m. During the tour, the LPA observed various kitchen cabinets and storage areas that did not contain any evidence of pest. Interview with staff members stated that because of the summer time being hot, there are very few pest at night but are taken care of by Terminex Pest control company. Additionally, LPA Ascencio obtained a copy to the Terminex service logs that indicate they are coming every 3 months for servicing. Although Administrator Illouz and staff indicated that they have seen pest in the kitchen area, during facility tour, LPA did not observe any evidence or signs of pest. Thus, the allegation is deemed unsubstantiated at this time.

LPA Ascencio spoke to Administrator Illouz regarding the hot water fluctuation and possible pest being observed. Administrator Illouz indicated clear understanding and stated Terminex will continue to fumigate and service the home, remodel the kitchen and update the water heater to mitigate hot water fluctuations.

Exit interview conducted and a copy of the report was issued to Administrator.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5