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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700186
Report Date: 02/24/2023
Date Signed: 02/24/2023 04:31:15 PM


Document Has Been Signed on 02/24/2023 04:31 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: DATE:
02/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Lacy BerryTIME COMPLETED:
05:00 PM
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On 2/24/2023, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a case management regarding a call response concern reported to the Department. LPA met with Administrator, Lacy Berry, and explained the purpose of the visit.

LPA was informed the call log system had recently stopped working, but was fixed the day of visit. LPA conducted an interview with Administrator, receptionist and (1) resident regarding the incident.

During today's visit, LPA toured the interior of the facility and observed R1's private room. LPA requested a copy of R1's call log to be emailed to LPA by Friday March 3, 2023. Administrator informed LPA the system will be fixed approximately by next week.

As a result of today's visit, no deficiencies were observed.

Exit interview conducted and a copy of the report was emailed to Administrator.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2023
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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