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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700186
Report Date: 05/22/2024
Date Signed: 05/22/2024 11:20:28 AM


Document Has Been Signed on 05/22/2024 11:20 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:WALNUT HOUSEFACILITY NUMBER:
342700186
ADMINISTRATOR:VICKY CROSSFACILITY TYPE:
740
ADDRESS:3401 WALNUT AVETELEPHONE:
(916) 483-6612
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:110CENSUS: 67DATE:
05/22/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Allison LopezTIME COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct an unannounced quarterly on-site visit regarding the Stipulation and Waiver and Order, effective two years from 05/23/2022 to 05/23/2024. LPA met with Facility Nurse, Allison Lopez, and explained the purpose of the visit.
During today's visit, LPA reviewed the Compliance Binder, and observed a copy of the Stipulation in the binder. LPA observed last weekly compliance calls conducted on 5/9/2024 with consultant group to discuss the medication room.

LPA observed Staffing Needs Call with Human Resources to be documented on 5/7/2024 regarding continuing interviews for med techs, caregivers and housekeeping. LPA observed documentation of Licensees quarterly on-site visits ensuring quality control conducted by Licensees, Solar Senior Living and CiminoCare.

LPA and Facility Nurse discussed the upcoming end of probation terms. LPA informed facility that once probation ends, a new license will be generated and mailed to the facility. At this time, LPA found facility to be in compliance with the Stipulations and Waiver; And Order.

No deficiencies cited.

Exit interview conducted and a copy of report will be provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2024
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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