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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000961
Report Date: 07/30/2024
Date Signed: 07/30/2024 05:00:05 PM


Document Has Been Signed on 07/30/2024 05:00 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:WALNUT VILLAGEFACILITY NUMBER:
306000961
ADMINISTRATOR:DEBORAH INFIELDFACILITY TYPE:
741
ADDRESS:891 WALNUT STREETTELEPHONE:
(714) 776-7150
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:300CENSUS: 174DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Debbie Infield- AdministratorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA met with Administrator Debbie Infield and explained the reason for the visit.

This a three story Residential Care for the Elderly Continuing Care Retirement Community. Facility is operating within the conditions and limitations specified on the license. LPA conducted a tour of the property with Administrator Infield and observed the facility to be clean and sanitary. LPA observed all common areas including the underground basement. LPA inspected seven resident bedrooms and seven resident bathrooms in unit and one in the common area on the first floor. The residents' bedrooms were appropriately furnished. Beds and bedding supplies/linens were in good condition and adequate lighting was provided. Residents had sufficient storage space for their personal belongings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature in the bathrooms measured within range between 107.6 to 116.6 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. The swimming pool was also secured. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen. LPA toured the exterior portion of the facility. LPA observed the outdoor area free of obstruction. LPA observed sufficient seating and shading. Facility maintains fire extinguishers which were mounted, charged, and serviced on August 15, 2023. The facility did not pass the quarterly fire inspection conducted on June 17, 2024. Per Administrator Infield, a subsequent inspection report will be provided to LPA after the following repair dates conducted by the fire company on July 31, 2024 and August 1, 2024. Emergency disaster supplies including food/water were present in the basement. Emergency evacuation drills were conducted on a quarterly basis with the last drill on April 9, 2024. The first aid kit contains all necessary elements. LPA observed the required 'See Something, Say Something' (PUB475) poster in the correct size. Based on the observations made during today's visit, no deficiencies are being cited. An Advisory Note is being issued. An exit interview was conducted with Administrator Debbie Infield, and copy of this report was provided at the end of the visit.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
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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