342700186-8-24-2023-59-AS-APEZ-D4PLWY-20240426090754

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700186
Report Date: 08/24/2023
Date Signed: 08/24/2023 06:01:33 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
05/05/2023 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 59-AS-20230505093715

FACILITY NAME:	WALNUT HOUSE		FACILITY NUMBER:	342700186
ADMINISTRATOR:	LACY BERRY		FACILITY TYPE:	740
ADDRESS:	3401 WALNUT AVE		TELEPHONE:	(916) 483-6612
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	110	CENSUS: 61	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Lacy Berry		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Resident was verbally abused by staff.
Facility does not ensure that residents are adequately fed.
Resident being served raw food.

INVESTIGATION FINDINGS:

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On 08/24/2023, Licensing Program Analyst (LPA) Cassie Yang and Licensing Program Manager (LPM) Laura Munoz arrived unannounced at the facility to deliver findings of the allegations cited above. LPA and LPM met with Administrator, Lacy Berry, and explained the purpose of the visit.

During the course of this investigation, the Department conducted extensive interviews and observations.

The result of the investigation is as follow.

Please continue on LIC 9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie Yang	TELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20230505093715

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: 08/24/2023

NARRATIVE

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Allegation: Resident was verbally abused by staff.

The Department conducted interviews with residents regarding the allegation of verbal abuse by staff. Although resident’s interviewed indicated PM staff can be discourteous and curt, there were reports of staff verbally abusing residents in care.

Based on information obtained through observation and interviews, the allegations listed above are UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Allegation: Facility does not ensure that residents are adequately fed.
Allegation: Resident being served raw food.

The Department conducted a tour of the kitchen in the facility and interviewed residents in care. Based on annual visit conducted on 08/24/2023, the facility served fried chicken, mash potatoes and gravy and cooked spinach. Based on interview conducted, it did not indicate residents has ever received raw, uncooked or under cooked food served at the facility.

Based on information obtained through observation and interviews, the allegations listed above are UNFOUNDED, meaning that the allegation was 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 left with Administrator.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie Yang	TELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

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