306000961-4-28-2025-22-AS-AJLO-DGESN7-20250506140105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000961
Report Date: 04/28/2025
Date Signed: 04/28/2025 03:49:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/10/2025 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250310104618

FACILITY NAME:	WALNUT VILLAGE		FACILITY NUMBER:	306000961
ADMINISTRATOR:	DEBORAH INFIELD		FACILITY TYPE:	741
ADDRESS:	891 WALNUT STREET		TELEPHONE:	(714) 776-7150
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92802
CAPACITY:	334	CENSUS:	DATE:	04/28/2025
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Joel Goldfain		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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-Facility staff is admitting residents to the memory care unit without prior consent from the residents and/or their authorized representatives.
-Facility staff are interfering with a resident from having visitors
-Facility staff are interfering with residents sleep
-Facility staff are not allowing resident to move freely around the facility
-Facility staff are not ensuring medication is being dispensed as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations.

Findings are based upon this investigation which included resident file review, tour of the physical plant of the facility and interviews conducted.

It is alleged facility staff is admitting residents to the memory care unit without prior consent from the residents and/or their authorized representatives. File review reveled that resident (R1) does not reside in the memory care unit. Admissions agreement reflects R1’s apartment number which is located in the assisted living side of the facility. However, R1 does attend respite care in the memory care unit of the

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250310104618

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WALNUT VILLAGE	FACILITY NUMBER: 306000961
	VISIT DATE: 04/28/2025

NARRATIVE

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facility for three days a week for a few hours, where R1 does activities. R1 resides in the independent side of the facility with their spouse. As of April 16, 2025, however R1 was transferred to the memory care unit and LPA received a copy of the transfer form from independent living to memory care signed by the authorized representative for R1.

It is alleged that staff is interfering with a resident from having visitors. In review of R1’s records reflects that there is a signed letter dates May 31, 2024, by R1 indicating the desire to not have visitations for one individual only and with instructions only allowed to call once a month, and there is no record of a resided letter from R1. In current times R1 works with facility staff to allow said individual to visit the facility at scheduled times and hours. Interview with Executive Director revealed that R1 is allowed to have visitors whenever R1 wanted to, however it is R1’s right to refuse visitors and therefore, generated the letter for restrictions of visitations.

It is alleged that facility staff are interfering with residents’ sleep. LPA on March 17th and April 14th toured the facility physical plant and the summer house 3 area. LPA observed ample space in the event that R1 wanted to take a nap while attending respite hours in the summer house 2. During the tour LPA observed a few residents napping in that are of the facility. Interview with 3 of 3 residents stated that they can sleep whenever they want to, the facility doesn’t tell them when to take naps and can take naps in their apartment as well as common spaces that have the capability for a nap.

It is alleged that facility staff are not allowing residents to move freely around the facility. LPA toured the facility on March 17, 2025, and April 14, 2025, and observed residents moving freely in the facility. LPA toured summer house 3 which is memory care unit and observed that it has egress doors, and a code is required for entry. Summer house 2 has its own patio designated for those residents. Interview with Executive Director states that R1 attends respite hours three times a week and if R1 gets a visitor during those hours they generally visit and stay in that area due to needing assess to come in and out. Any resident is allowed to move freely in the facility with no restrictions. R1 had a visitor and was visiting in the putting green of the facility, R1 as at respite care and since respite care is held at the summer house 2 they need

Continued on LIC9099-C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250310104618

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WALNUT VILLAGE	FACILITY NUMBER: 306000961
	VISIT DATE: 04/28/2025

NARRATIVE

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access to travel out of that area. Summer house 2 has a patio and putting green that can be used for visitations if needed. Interview with 3 of 3 residents stated that they can move freely in the facility with no restrictions and use all the common spaces without a problem.

It is alleged that facility staff are not ensuring medication is being dispensed as prescribed, furthermore complaint details states R1’s spouse is not properly dispensing medication. Record review for appraisal/needs and services plan reflects medication management walnut village staff to store, order and dispense medication as ordered by physician dated October 10,2023. Interview with 2 of 2 staff stated that R1 has been on medication management by facility since 2023 and spouse do not have access to the medication. When R1 and spouse moved in med management wasn’t being done, but that changed a few months after moving into the facility and since then facility is responsible for dispensing medication.

Based on the information gathered during the investigation, interviews and review of all documents obtained, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

This report was reviewed with facility representative, and a copy was furnished to the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

LIC9099 (FAS) - (06/04)

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