Walnut Garden IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 9:55AM. The LPA met with the Administrator Ayalla Levy and Licensee Izhak Illouz arrived shortly thereafter. Entrance interview conducted. Beginning at 9:58AM, the LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS/RESTROOMS: There are seven (7) total bedrooms; six (6) private resident bedrooms and one (1) locked staff bedroom. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens are stored in the hallway cabinets. There are seven (7) total restrooms in the facility: five (5) attached private resident restrooms, one (1) designated staff and visitor restroom, and one (1) shared resident restroom. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 112.6 degrees F and 115.3 degrees F. Report Continued on LIC 809-C NOTE: Report amended to clarify LPA's visit time of 09:55AM to 12:15PM. Report emailed to Licensee for signature. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition with activity storage. A screened and inoperable fireplace was observed. Required postings were located in the living room near a secured closet that contained general storage. A locked laundry room was located in the hallway and contained an operable washer/dryer, laundry supplies, and household cleaning supplies. The facility maintained a comfortable temperature throughout the visit. KITCHEN: Knives are stored inaccessible in a locked drawer and cleaning supplies inaccessible under the sink. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food. Food in the refrigerator and freezer were observed to be properly stored. OUTDOOR AREA: The surrounding grounds had multiple shaded patio areas equipped with furniture in good condition for resident and visitor use. There is one driveway gate used for emergency exits with two pathways on both sides of the house that lead to the front yard/driveway. No bodies of water noted, and exits are free of obstructions. The LPA observed three (3) sheds in the backyard that stored extra freezer foods, emergency water, and general storage. The sheds remain locked and inaccessible to residents in care. RECORDS: Record review began at 10:33AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Fire extinguishers were observed throughout the facility and were last serviced on 01/06/2026. Emergency disaster drills are conducted quarterly, with the last documented drill on 02/05/2026. Smoke and carbon monoxide detectors were tested at 11:16AM and were operational. MEDICATIONS: Medication review began at 11:19AM. Medications are centrally stored and kept inaccessible in the hallway closet. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, May 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 10:45AM. The LPA was greeted by staff, informed them of the reason for the visit, and staff proceeded to notify the Administrators. Assistant Administrator Ayalla Levy arrived shortly thereafter, and Administrator Izhak Illouz arrived at 11:07AM. Entrance interview conducted. Beginning at 10:51AM, the LPA, House Manager, and Assistant Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS/RESTROOMS: There are seven (7) total bedrooms; six (6) private resident bedrooms and one (1) locked staff bedroom. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens are stored in the hallway cabinets. There are seven (7) total restrooms in the facility: five (5) attached private resident restrooms, one (1) designated staff and visitor restroom, and one (1) detached private restroom for one (1) resident. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 107.4 degrees F and 135.5 degrees F, which was not in the required range of 105 degrees F and 120 degrees F. Administrator Izhak lowered the water heater during the visit, but was unsuccessful in lowering the water temperature. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. LPA observed residents and staff participating in a weekly music class and noted additional activities stored in the living room. Required postings were located in the living room near a closet that contained general storage. A locked laundry room was located in the hallway and contained an operable washer/dryer, laundry supplies, and household cleaning supplies. The facility maintained a comfortable temperature throughout the visit. Smoke and carbon monoxide detectors were tested at 12:42PM and were operational at the time of the visit. Fire extinguishers were observed throughout the facility and was last serviced on 01/03/2025. KITCHEN: The LPA observed the facility kitchen at 11:10AM. Knives are stored inaccessible in a locked drawer between the stove and sink. Cleaning supplies were stored inaccessible and locked under the sink. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food and water within regulation. Food in the refrigerator and freezer were observed to be properly stored. OUTDOOR AREA: The surrounding grounds had multiple shaded patio areas equipped with furniture in good condition for resident and visitor use. There is one driveway gate used for emergency exits with two pathways on both sides of the house that lead to the front yard/driveway. No bodies of water noted, and exits are free of obstructions. The LPA observed three (3) sheds in the backyard that stored extra freezer foods, extra emergency food and water, and general storage. The sheds remain locked and inaccessible to residents in care. RECORDS: Record review began at 11:25AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. LPA observed two (2) out of six (6) staff did not have a health screening, and one (1) out of six (6) staff did not have a TB test upon their employment with the facility. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 04/30/2025. MEDICATIONS: Medication review began at 2:30PM. Medications are centrally stored and kept inaccessible in the hallway closet. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Three (3) staff and two (2) family members of residents were interviewed. No complaints noted. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Emily Peraldi conducted a pre-licensing visit to the above noted facility. At 10:30 a.m., the LPA met with applicant, Izhak Illouz. This is a change of ownership application. A dementia program was included in the plan of operation. A Hospice Waiver for six (6) has been requested. At 10:40 a.m., a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory residents and one (1) bedridden resident. The facility is one story. The facility has six (6) resident bedrooms. All resident bedrooms have a direct exit to the outside except bedroom #4 and #5. Bedridden resident is allowed in resident bedroom #1. All resident rooms are set up with beds, nightstands, lamps, chairs, chest of drawers and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed). Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There is one (1) additional room used for staff. All rooms were free of odors. All window screens were clean and maintained in good repair. There are seven (7) bathrooms in the facility, and the bathroom located in one of the main hallways is designated for staff and guests. The resident bathrooms have a shower with non-skid materials/ mats. The toilet and shower have grab bars. The hot water temperature was tested in the bathroom and the kitchen and was found to be within the range of 105*F and 120*F. Resident and staff records are stored in the office area. Medications are centrally stored in locked hallway closet. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. Continued on LIC 809-C. Kitchen knives are stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable and perishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area. Appliances in the kitchen were clean and all appeared functional. Laundry units and house cleaning supplies are stored inside the locked laundry room. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment, games and/or activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included but not limited to flashlights. The facility had emergency food and water supplies. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. At 11:15 a.m., the smoke detector and carbon monoxide detectors were tested and functioned properly. The facility has a central entry point for symptom screening and temperature checks for staff and visitors. There are hand sanitizers available throughout the facility. The fire extinguishers throughout the facility were fully charged and last serviced on 02/06/2024. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored throughout the facility. Extra incontinence supplies and other supplies are located outside in the locked storage sheds. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted throughout the facility. The emergency telephone numbers are posted near the entrance of the facility. Other required postings are also posted near the entrance of the facility. Continued on LIC 809-C. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. The property is gated. One side of the house is designated for an emergency exit. There are locked storage sheds in the back yard. There are no bodies of water on the premises at the present time. Component III was conducted in conjunction with this pre-licensing visit. No corrections required. Exit interview conducted. A copy of the report was issued. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.the state’s words, verbatim · CDSS document, May 3, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Licensee/administrator Izhak Illouz Interview Method: Telephone interview On 04/09/2024 applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 9, 2024