<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000961
Report Date: 02/21/2023
Date Signed: 02/21/2023 10:12:49 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/12/2022 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221212135103
FACILITY NAME:WALNUT VILLAGEFACILITY NUMBER:
306000961
ADMINISTRATOR:NADINE A. ROISMANFACILITY TYPE:
741
ADDRESS:891 WALNUT STREETTELEPHONE:
(714) 776-7150
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:300CENSUS: 191DATE:
02/21/2023
UNANNOUNCEDTIME BEGAN:
09:51 AM
MET WITH:Debbie InfieldTIME COMPLETED:
10:25 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff does not treat resident with respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit to deliver the findings into the above allegation. LPA Cho met with Executive Director (ED) Debbie Infield and stated the purpose of the visit. During the course of the investigation, LPA obtained and reviewed pertinent records for Resident 1 (R1), conducted interviews with R1 and the ED, and toured the library. The investigation revealed the following:

It was alleged that the facility staff did not treat the resident with respect. Per review of the facility’s Shift Report, on December 2, 2022, R1 was asked to self-isolate due to pending Coronavirus 2019 (COVID-19) test results. R1 was observed and approached by the ED in the library and was asked to return to the apartment out of precaution. Interviews conducted revealed that R1 did not like the ED’s tone while the ED indicated that she spoke to R1 in a low voice. Due to conflicting statements, LPA is unable to corroborate the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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 2
Control Number 22-AS-20221212135103
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 02/21/2023
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
26
27
28
29
30
31
32
Therefore, based on record review and interviews, the allegation is deemed UNSUBSTANTIATED meaning, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with Executive Director Debbie Infield, and this report was provided during this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2