Walnut Garden V

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility to conduct an unannounced required one-year visit. The LPA arrived at 10:18AM and met with the Administrator Arlene Ceballos and Licensee Izhak Illouz. Entrance interview conducted. Beginning at 10:22AM, the LPA and the Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature throughout the visit. LPA Huynh noted required signage and postings in the facility’s entryway. KITCHEN: Knives were stored inaccessible in a locked drawer. Cleaning supplies were inaccessible under the sink. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food, as well as emergency food. Food in the refrigerator and freezer were observed to be of good quality with dates. Files and medications were stored in a locked cabinet. Laundry machines were observed and were in good condition. Report Continued on LIC 809-C OUTDOOR AREA: The backyard had several areas equipped with furniture for resident and visitor use. There was a detached garage that contained emergency water and general storage. There were two (2) self-latching side gates for emergency use. No bodies of water noted, and exits were free of obstructions. BEDROOMS/RESTROOMS: There were six (6) total private resident bedrooms. Bedrooms #4, #5, and #6 had direct exits to the outside with Bedroom #6 approved for one (1) bedridden resident. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. A dresser with extra linens was observed in the hallway. There were six (6) total restrooms in the facility: five (5) private resident restrooms and one (1) common area restroom in the hallway. Restrooms were clean, sanitary, and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap and paper products. Hot water was tested and measured between 114.1 degrees F and 119.1 degrees F. RECORDS: Record review began at 10:51AM. 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 files were in order. 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. Emergency disaster drills are conducted quarterly, with the last documented drill on 04/10/2026. Smoke and carbon monoxide alarms were tested at 11:42AM and were operational. Fire extinguishers were observed throughout the facility and were last serviced 1/5/2026. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 11:55AM. Medications were centrally stored and kept inaccessible in the kitchen. 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 today's report was reviewed and provided.the state’s words, verbatim · CDSS document, Jun 4, 2026

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility to conduct an unannounced Post-Licensing visit at 9:37AM. The LPA was greeted by staff and met with the Administrator Arlene Ceballos. The Licensee Izhak Illouz arrived shortly thereafter. Entrance interview conducted. Beginning at 9:42AM, the LPA and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature throughout the visit. LPA Huynh noted required signage and postings in the facility’s entryway. KITCHEN: Knives were stored inaccessible in a locked drawer. Cleaning supplies were inaccessible under the sink. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food, as well as emergency food. Food in the refrigerator was observed to be of good quality with dates. Files and medications were stored in a locked cabinet. Laundry machines were observed and were in good condition. Report Continued on LIC 809-C OUTDOOR AREA: The backyard had several areas equipped with furniture for resident and visitor use. There was a detached garage that contained emergency water and general storage. There was two (2) self-latching side gates for emergency use. No bodies of water noted, and exits were free of obstructions. BEDROOMS/RESTROOMS: There were six (6) total private resident bedrooms. Bedrooms #4, #5, and #6 had direct exits to the outside with Bedroom #6 approved for one (1) bedridden resident. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. A dresser with extra linens was observed in the hallway. There were six (6) total restrooms in the facility: five (5) private resident restrooms and one (1) common area restroom in the hallway. Restrooms were clean, sanitary, and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap and paper products. Hot water was tested and measured between 102.6 degrees F and 119.1 degrees F. RECORDS: Record review began at 10:04AM. 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 files were in order. 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 recently. Emergency disaster drills are conducted quarterly, with the last documented drill on 10/25/2025. Combination smoke and carbon monoxide alarms were tested at 10:38AM and were operational. Fire extinguishers were observed throughout the facility and were last serviced 1/3/2025. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 10:45AM. Medications were centrally stored and kept inaccessible in the kitchen. 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 today's report was reviewed and provided.the state’s words, verbatim · CDSS document, Nov 13, 2025

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Quoc Huynh and Kelly Dulek conducted a pre-licensing visit to the above noted facility. At 10:20AM, the LPAs met with applicant, Izhak Illouz. An application to operate a Residential Facility for the Elderly was submitted on 12/02/2024. A dementia program was included in the plan of operation. A Hospice Waiver for 6 (six) has been requested. The facility's fire clearance was approved on 01/03/2025 for 1 (one) bedridden and 5 (five) non-ambulatory, with a total capacity of 6 (six) residents. Component II orientation was completed on 04/14/2025. Component III was completed with the applicant during today's visit. The facility is a single story home located in Valley Village. Beginning at 10:35AM, a physical plant tour was conducted. The following was observed: 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 foods and emergency food supply is adequate. Cleaning supplies are stored in a locked cabinet under the kitchen sink. 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. Medication will be stored in a locked kitchen cabinet. First aid kit was observed to be complete, including a thermometer and a current version of a first aid manual. Files will be stored in a separate locked kitchen cabinet. Washer and dryer were observed in the kitchen area and appeared to be operable. The facility has six (6) resident bedrooms. Bedrooms #4, #5, and #6 have direct access to the outside. Bedridden resident is allowed in resident bedroom #6. Resident rooms are set up with beds, nightstands, lamps, chairs, sufficient clothing storage 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 Report Continued on LIC 809-C. 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. All rooms were free of odors. All window screens were clean and maintained in good repair. There are 6 (six) bathrooms in the facility; 5 (five) are for private resident use and 1 (one) is for shared use. The resident bathrooms have a shower with slip-resistant materials and available mats. The toilet and shower have grab bars. The hot water temperature was tested in various bathrooms and measured within the required range of 105*F to 120*F. 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. 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 available. The facility has central heating and air conditioning to maintain rooms to a comfortable temperature. At 10:52AM, the hardwired combination smoke and carbon monoxide detectors as well as fire doors were tested and functioned properly. The fire extinguishers throughout the facility were fully charged and last serviced on 01/03/2025. 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 shed and detached garage. There is a functioning telephone on the premises. All required postings are posted near the entrance of the facility. 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 outdoor space is property gated. There are locked storage sheds in the back yard. There are no bodies of water on the premises at the present time. 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 21, 2025

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): COMP II Participants: ISHAK ILLOUZ Interview Method: Telephone interview On 4/14/25, 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 14, 2025