306000961-6-8-2022-22-AS-ETAA-CF7RDY-20220608125644

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306000961
Report Date: 06/08/2022
Date Signed: 06/08/2022 12:56:53 PM

Document Has Been Signed on 06/08/2022 12:56 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	WALNUT VILLAGE		FACILITY NUMBER:	306000961
ADMINISTRATOR:	NADINE A. ROISMAN		FACILITY TYPE:	741
ADDRESS:	891 WALNUT STREET		TELEPHONE:	(714) 776-7150
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92802
CAPACITY:	300	CENSUS: 184	DATE:	06/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Joel Goldfain, Pamela Lowe, Debbie Infield		TIME COMPLETED:	01:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection at this facility. LPA met with staff Joel Goldfain and Pamela Lowe and stated the purpose of this visit. Executive Director Debbie Infield arrived during the visit at 11:30 AM and provided assistance. The facility is a three level structure and licensed for 138 non-ambulatory with a hospice waiver for 20. This facility is a Residential Care For the Elderly Continuing Care. At 9:14 AM, LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA did not observe the PUB475 See Something, Say Something poster posted by the front desk. LPA toured the interior and exterior portions of the facility. LPA Tapia inspected seventeen rooms at random. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Hardwired smoke, carbon monoxide, and auditory exit alarms were tested to be operational. All bathrooms were provided with grab bars and non-skid floor mats, and hot water measured between the ranges of 72.8 to 109.9 degrees Fahrenheit. LPA made staff aware that water temperature needs to be from 105 to 120 degrees Fahrenheit. LPA Tapia observed hand washing signs in the community bathrooms but none in the resident's bathrooms. Facility had hand sanitizers mounted on the wall throughout the facility and in the common areas. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Facility had adequate supplies of personal protective equipment in place. Fire extinguishers were mounted and charged. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward Tapia	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: WALNUT VILLAGE	FACILITY NUMBER: 306000961
	VISIT DATE: 06/08/2022

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Facility did have two fountains and rose bushes. Facility had an underground garage LPA Tapia reviewed the COVID 19 mitigation plan of the facility. LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.

For this visit, no deficiency was noted in areas observed. No citation was issued. Three advisories were issued.

LPA Tapia conducted an exit interview with Executive Director Debbie Infield ; and copy of this report was left at the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward Tapia	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

LIC809 (FAS) - (06/04)

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