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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700186
Report Date: 07/20/2022
Date Signed: 07/21/2022 08:04:14 AM


Document Has Been Signed on 07/21/2022 08:04 AM - 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:WALNUT HOUSEFACILITY NUMBER:
342700186
ADMINISTRATOR:LACY BERRYFACILITY TYPE:
740
ADDRESS:3401 WALNUT AVETELEPHONE:
(916) 483-6612
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:110CENSUS: 67DATE:
07/20/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lacy Berry, Administrator, Adina Nitu, Regional Director and Mark Cimino, CEOTIME COMPLETED:
11:30 AM
NARRATIVE
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An office meeting was held on 07/20/2022 at 10:30 AM on a Microsoft Teams Meeting video conferencing
system review the stipulation adopted on 05/23/2022 and the next steps. This Stipulation shall be posted in a
conspicuous place at the facility for the duration of the probationary period.

The following were in attendance: Regional Manager Alycia Berryman, Licensing Program Manager Maribeth
Senty, Licensing Program Analysts Cassie Yang and Sabrina Calzada, Representatives of Solar Senior Living, LLC and Ciminocare and Josh Allen, from Allen Flores Consulting Group.

Alycia Berryman discussed the purpose and elements of this type of meeting.

The Stipulation was reviewed with Representatives, Administrators, and Licensees who expressed their
understanding.

Items discussed at the meeting included, but not limited to:
Stipulation contents
· Findings
· Revocation of License- Stayed with Probation
· Early Termination of Probation at Department’s discretion
· Future Application for a license, registration, certification or approval
· Completion of probation
· Violation of Stipulation Term
· Lacy Berry- Exclusion, stayed with probation
· Lacy Berry- Revocation of Administrator’s certificate, stayed with probation
· Lacy Berry: Terms of probation

cont on 809C..
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: WALNUT HOUSE
FACILITY NUMBER: 342700186
VISIT DATE: 07/20/2022
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· Early Termination of probation at Department’s discretion
· Lacy Berry: Future application for a license, registration, certification or approval
· Lacy Berry: Completion of probation
· Lacy Berry: Violation of stipulation term
· Tolling of probationary period
· Department’s Authority
· Monitoring Fee
· Waiver of Hearing Rights
· Waiver of Appeal/Modification Rights
· Waiver of Claims
· Public Record
· Signatures
· Counterparts
· Effective Date (5/23/22- 5/23/24)
· No Oral modification
· Representations regarding Corporate License

The Licensees/Respondents/Representatives stated they would abide by the following:
ꞏ Abide by the contents/terms of the Stipulation (submit all documents timely)
ꞏ Operate the facility in strict compliance with the regulations and statutes governing the operation of a
residential care facility for the elderly.

CCLD will do the following:
ꞏ Increase monitoring

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations cited during this visit. A virtual exit interview was conducted, and a copy of this report was provided via email for a signature. Administrator agreed to return a signed copy to CCLD by COB 7/20/22.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC809 (FAS) - (06/04)
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