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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700186
Report Date: 01/26/2023
Date Signed: 01/26/2023 05:10:42 PM


Document Has Been Signed on 01/26/2023 05:10 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
CHICO - RESIDENTIAL, 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: 51DATE:
01/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lacy Berry, AdministartorTIME COMPLETED:
05:15 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) Cassie Yang arrived unannounced at the facility to conduct an unannounced quarterly on-site visit pursuant to a Stipulation and Waiver and Order adopted on 05/23/2022. LPA met with Lacy Berry, Administrator, and explained the purpose of the visit.

During today's inspection, LPA observed a copy of the Stipulation in the binder and at a conspicuous place by the front desk. LPA reviewed the "Walnut House Compliance Binder" and observed to contain tab dividers for each requirement listed in the Stipulation and Waiver; and Order.

LPA observed the weekly calls with Alan Flores Consulting Group to be completed weekly with the most recent call to be on 1/19/23. LPA observed the monthly task of reviewing residents service plan to be up to date from June 2022 to January 2023. LPA observed the monthly staffing needs call with Human Resources to be completed on 1/24/23. LPA observed the recent quarterly clinical audit was conducted on 1/5/2023 as well as an on-site visit on 10/11/2022.

As a result of today's visit, no citations cited.

Exit interview conducted. Copy of report provided to Administrator.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1