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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802837
Report Date: 04/25/2023
Date Signed: 04/25/2023 01:25:05 PM


Document Has Been Signed on 04/25/2023 01:25 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:WALNUT VILLA - TELEGRAPH IFACILITY NUMBER:
197802837
ADMINISTRATOR:HASS, SCOTTFACILITY TYPE:
740
ADDRESS:13971 TELEGRAPH ROADTELEPHONE:
(562) 777-7200
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:6CENSUS: 0DATE:
04/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Celina VasquezTIME COMPLETED:
01:00 PM
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Licensing Program Analyst/ (LPA) Angelica Rea, conducted an unannounced annual inspection visit at the Walnut Villa - Telegraph I facility. LPA was allowed entry into the facility by Celina Vasquez, Administrator. LPA Rea explained to Ms. Vasquez the purpose of the required 1 year annual inspection visit.

Ms. Vasquez informed LPA that there are currently no residents residing in Walnut Villa - Telegraph I. LPA toured the facility with Ms. Vasquez.. The residential house is one of three residential homes (on the property) has three bedrooms, one bathroom, kitchen, dining room, living room, and storage room. LPA toured the house and did not observe any residents living in the facility. Ms. Vasquez informed LPA that she faxed and mailed, the Monterey Park CCL Office, a letter stating that there are no residents living in the facility, and that the current owners of the facility are planning to refurbish the house for future residents to be admitted. LPA informed Ms. Vasquez to contact the Community Care Licensing office prior to beginning renovations on the property..

The Administrator stated that they still want to maintain the license and remain operational.

No deficiencies cited. An exit interview was conducted and a copy of this report was provided to Ms. Vazquez.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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