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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700186
Report Date: 12/05/2024
Date Signed: 12/05/2024 04:52:18 PM

Document Has Been Signed on 12/05/2024 04:52 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WALNUT HOUSEFACILITY NUMBER:
342700186
ADMINISTRATOR/
DIRECTOR:		LOPEZ, ALLISONFACILITY TYPE:
740
ADDRESS:3401 WALNUT AVETELEPHONE:
(916) 483-6612
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 110TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
12/05/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Allison Lopez and Robert GodfreyTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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An office meeting was held via Microsoft Teams on December 5, 2024 at 1:00 PM, to discuss Long Term Care Ombudsman's current concerns at the facility.

Present in the meeting are: Licensing Program Manager, Anthony Perez, Licensing Program Analyst, Cassie Yang, Long Term Care Ombudsman, Randy Dinning, Facility Administrator, Allison Lopez, and CiminoCare Regional Director Robert Godfrey.

Topics discussed:
  • Medication Procedure
  • Resident and Family Council


Exit interview conducted and a copy of the report was provided.

Anthony PerezTELEPHONE: (323) 485-4915
Cassie YangTELEPHONE: (916) 201-1928
DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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