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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000961
Report Date: 04/07/2025
Date Signed: 04/07/2025 05:02:04 PM

Document Has Been Signed on 04/07/2025 05:02 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/
DIRECTOR:		DEBORAH INFIELDFACILITY TYPE:
741
ADDRESS:891 WALNUT STREETTELEPHONE:
(714) 776-7150
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 334CENSUS: 198DATE:
04/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Deborah InfieldTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst William Vanegas made an unannounced inspection for the purposes of conducting an annual inspection and conducting an inspection for the expanded memory care unit. Upon arrival LPA Vanegas met with Administrator Deborah Infield and explained the purpose of the inspection.

LPA Vanegas set up equipment and began a tour of the facility and observed the following, This is a gated community with a total of 198 residents. There is a large pool that is enclosed, and is accessible to residents in care using a key fob to open the pool door. Any residents that are in the memory care unit are accompanied by facility staff, or personal care giver.

LPA Vanegas toured expanded memory care unit building, and observed it to be in good repair with all required components in order to be licensed. Updated fire clearance was received on March 6, 2025. Capacity increase was updated from 300 to 334 residents. LPA Vanegas observed quarterly testing log for facility to be updated and all smoke and carbon monoxide detectors tested operational and were observed to be in good repair. LPA Vanegas observed fire extinguishers to be fully charged and up to date.

LPA Vanegas observed kitchen area to be inaccessible to residents in care, and for their to be a food menu and activity board posted in the proper locations and accessible to residents in care. Sharps, toxins, and medications are locked away and inaccessible to residents in care. LPA Vanegas observed a fountain in the main courtyard, how ever it does not have a large body of water. LPA Vanegas observed resident rooms to have all required furnishings such as a bed, clean linens, a lamp, chair, chest drawer and enough closet space for personal items.
CONTINUED ON LIC809C
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: WALNUT VILLAGE
FACILITY NUMBER: 306000961
VISIT DATE: 04/07/2025
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LPA Vanegas reviewed eight resident files and eight staff files. All files (resident and staff) had all required documents. LPA Vanegas reviewed medications with medtech staff and administrator and observed all medications to be documented correctly and administered per doctors orders.

LPA Vanegs observed facility restrooms to be clean and free of any mildew and debris, and to contain all required furnishings such as a shower chair, grab bars, and slip resistant floor mats. LPA Vanegas observed water temperature to be between 114.8 and 116.7 degrees.

Based on observations made during todays visit no deficiencies will be sited per tittle 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Deborah Infield and a copy of this report was left at the facility.
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2025
LIC809 (FAS) - (06/04)
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