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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003743
Report Date: 11/08/2021
Date Signed: 11/08/2021 02:00:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:WALNUT HOME CAREFACILITY NUMBER:
347003743
ADMINISTRATOR:OLTEAN, MARIANAFACILITY TYPE:
740
ADDRESS:4120 WALNUT AVENUETELEPHONE:
(916) 718-6870
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
11/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Dianne Oltean, Administrator TIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Tracey, caregiver, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA confirmed there are no residents or staff with a confirmed case or signs/symptoms or Covid. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA observed all (6) in their private resident rooms. LPA was advised there is (1) resident is on hospice. LPA met with Administrator, Dianne, who arrived shortly to the facility.

LPA and caregiver toured the interior of the facility. LPA observed it to be clean and in good repair. LPA observed various Covid posters throughout.. Rooms toured include (6) private bedrooms and (2) caregiver rooms, (3) bathrooms, kitchen, laundry, garage and common areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and caregiver completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 72* F. LPA observed sufficient 2+day perishable and 7+day non-perishable food. LPA observed paper towels, soap and sanitizer, trash can with lid and hand-washing poster in the bathrooms. Discussed vaccination status of residents and staff.
Current copies of Administrator certificates posted. Fire extinguisher serviced 10/27/2021.

There were no deficiencies observed during today's inspection. LPA requested updated copy of liability insurance and LIC308.

Exit interview. Copy of report to be e-mailed to facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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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