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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700186
Report Date: 01/11/2024
Date Signed: 01/11/2024 04:32:21 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/29/2023 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20230829093013
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:
01/11/2024
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Lacy Berry and Alison LopezTIME COMPLETED:
04:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not properly trained.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/11/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the finding for the allegation cited above. LPA met with Administrator, Lacy Berry, and explained the purpose of the visit.

During the course of investigation, LPA conducted file review of S1, S2 and S3 training.

The result is as follow, please see LIC 9099-C.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 59-AS-20230829093013
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WALNUT HOUSE
FACILITY NUMBER: 342700186
VISIT DATE: 01/11/2024
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
26
27
28
29
30
31
32
LIC 9099-C...

Allegation: Staff are not properly trained.

Based on Relias file review, it revealed S1 completed total training hours of 17.25 from 06/26/2023 to 06/28/2023 and additionally one (1) hour of Refresher for CPR on 08/28/2023. File review on Guardian revealed S1 was added as an employee on 06/13/2023. Based on Relias file review, it revealed S2 completed total training hours of 23.75 from 06/30/2023 to 07/27/2023. File review on Guardian revealed S2 was added as an employee on 06/09/2023. Based on Relias file review, it revealed S3 completed total training hours of 20.25 from 08/18/2023 to 08/23/2023. File review on Guardian revealed S3 was added as an employee on 07/18/2023.

Based on information obtained, LPA finds the allegation to be UNFOUNDED-means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted, and a copy of the report and appeal rights was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2