Walnut Garden Valley Village

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 10:18AM. The LPA met with the Administrator Arlene Ceballos and Licensee Izhak Illouz arrived shortly thereafter. Entrance interview conducted. Beginning at 10:24AM, 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 were six (6) total bedrooms, each private. Bedrooms #3 and #4 have direct exits to the outside with Bedroom #4 cleared for one (1) bedridden resident. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were stored in a closet located in the hallway. There were four (4) total restrooms in the facility: three (3) private resident restrooms and one (1) common restroom. Restrooms were clean, 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. Sink cabinets were locked and contained hygiene products. Hot water was tested and measured between 109 degrees F and 115 degrees F, which is within the required range per regulation. 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. Required postings were located near the entryway. The facility maintained a comfortable temperature throughout the visit. Night lights and exit signs were observed throughout the facility. The facility had a den that was utilized as a staff break room as well as a general private meeting area. KITCHEN: The LPA observed knives, medications, and cleaning supplies secured. 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 with labels and dates. Attached to the kitchen was a laundry room with machines in good condition. OUTDOOR AREA: The surrounding grounds had a shaded patio area equipped with furniture in good condition for resident and visitor use. There were two (2) emergency exits located on the sides of the facility with a self-latching mechanism. All exits and passageways were free of obstructions. There was a garage that contained general storage, extra food, and emergency water. RECORDS: Record review began at 10:48AM. 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. MEDICATIONS: Medication review began at 11:54AM. 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 and were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. The Licensee and Administrator were advised to maintain medications in their original containers. 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 was last serviced on 01/05/2026. Emergency disaster drills are conducted quarterly, with the last documented drill on 01/08/2026. Smoke and carbon monoxide detectors were tested at 12:07PM and were operational. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 11, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:30 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator arrived shortly thereafter. The LPA met with Izhak Illouz –Licensee Representative / Administrator and explained the reason for the visit. The LPA 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. KITCHEN: The LPA inspected the kitchen/food service area at 9:42 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. Chemical storage is kept locked under the sink. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 115.1 degrees Fahrenheit at 9:43 a.m. LPA observed an adequate amount of emergency food located in one of the kitchen cabinets adjacent to the refrigerator and in the garage. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 10:09 a.m., hardwire combination of smoke / carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers were observed and fully charged on 1/03/2025. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 01/06/2025 and are conducted quarterly. Activities were observed in the common areas. A non-functional fireplace was noted in the living room covered by a bookshelf. Adjacent to the kitchen is a laundry room / area with a washer and dryer. Laundry detergent was observed locked in the garage. A small storage room containing extra mobility supplies and oxygen was noted at the entrance way adjacent to the living room. The facility has a working telephone on premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits were free of obstruction. Report Continued on LIC 809C... Report Continued from LIC 809... RESTROOMS: There are four (4) restrooms. Three (3) are designated for resident use and one (1) is designated as a staff/guest restroom; however, can be used by residents in an emergency. Resident restrooms were observed to be equipped with slip resistant surfaces. Grab bars were observed in the bathrooms. The restrooms were sufficiently stocked with supplies and paper towels. The water temperature was measured in all resident restrooms from 9:56 a.m. – 10:05 a.m. and ranged between 115.2-115.3 degrees Fahrenheit all within the required range. BEDROOMS: There are six (6) total bedrooms in the facility; five (5) bedrooms are designated as private resident rooms and one (1) staff room. The staff room remains locked at all times. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #3 and #4 have a direct exit to the exterior. Bedroom #4 and #5 have a Jack and Jill bathroom. GARAGE/BACKYARD: The garage is maintained locked at all times. LPA observed an adequate amount of emergency food and water. LPA observed two (2) extra refrigerators with food that was checked for proper labels and expiration dates. Cleaning supplies are kept in the garage locked and inaccessible to residents in care. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed two (2) self-latching gates. There were no bodies of water noted at the time of the visit. RECORDS: Record review began at approx. 10:15 am. Resident Records began at 10:15 a.m. Five (5) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Personnel Records were reviewed beginning at 10:57 a.m. Four (4) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. MEDICATIONS: Medications review began at approximately 11:40 a.m. The medications are in a locked cabinet in the kitchen. Medications for five (5) residents were reviewed. Medications reviewed including PRNs were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. Medications were labeled, stored, and locked inaccessible to residents. Medications were checked for expiration dates. PRNs have physicians order on file. No medication errors observed at this time. Report Continued on LIC 809C... Report Continued from LIC 809C... INTERVIEWS: Two (2) staff interviews and two (2) resident interviews were conducted from 11:25 a.m. – 11:40 a.m. during the inspection. Staff interviews revealed that staff are knowledgeable in resident rights, different forms of abuse and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. LPA obtained the following documents LIC 500 - Personnel Report, LIC 9020 - Resident Roster, and current liability insurance. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report reviewed and provided.the state’s words, verbatim · CDSS document, Jan 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) Valeria Conway and Kelly Dullek arrived at the facility at 9:10AM unannounced to conduct a required Annual visit. The last annual conducted at this facility was on 12/21/2022. The LPAs met with Staff to explain the reason for the visit. Administrator Arlene Ceballos and Izhak Illouz arrived at the facility shortly thereafter. The LPA’s toured the physical plant areas inside and outside, with Administrator Izhak Illouz at 9:40 A.M., to ensure there are no health and safety hazards. Last Emergency Drill (Fire and Earthquake) was done on 01/08/24. BEDROOMS: There are (6) six bedrooms designated for resident use, all resident bedrooms are private rooms and (1) one bedroom designated for staff use. Bedroom #3 and Bedroom #4 have a direct exit to the exterior. Bedroom #4 and #5 has a Jack and Jill bathroom. The facility has furnished each room with clean linens, nightstands, lamps, chests of drawers, chairs and closet space, and sufficient lighting for resident use. The bedrooms were large enough to allow for easy passage. RESTROOMS: Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. There are (4) four total bathrooms at the home. (2) Two are private bathrooms in Room #2 and #3. Restroom hot water measured 115.5 degrees Fahrenheit at 10:05 A.M. Continue on LIC 809C Continued from LIC 809 KITCHEN: Appliances in the kitchen were clean and all appeared functional. The facility has a sufficient supply of perishable and non-perishable food. Knives are stored in a locked cabinet and inaccessible in the kitchen as well as medications and chemicals. Appliances in the kitchen were clean and all appeared functional. Laundry and house cleaning supplies are stored in a locked cabinet under the kitchen sink and inside the outside garage. FILES: During today’s visit, the LPAs observed full bed rails on the bed of Resident #2. The Administrator stated that resident in room #2 is receiving hospice care services at the time of the visit. The Administrator provided bed-rail order. Staff file review revealed that Staff #1 (S1) and Staff #2 (S2) didn’t have health screening LIC503 nor TB Test negative results. COMMON SPACES: The common spaces included the living room and dining area. The LPAs observed cameras in all common spaces and a screened fireplace in the living room. All areas were clean, sanitary and in good repair. Smoke detector(s) and carbon monoxide detector were tested at 9:55 A.M. and operational at the time of the visit, they are hardwired and interconnected. The fire extinguishers were observed to be in compliance and last charged on 02/16/2024. The LPA's observed required postings on the wall leading to the kitchen. At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a working telephone on premises. Auditory alarms were functioning at the time of the visit. An adequate supply of emergency food and water was observed at the time of the visit. BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. The facility has one (2) side gates that self-latches. No bodies of water noted at the time of the visit. Continued from LIC 809C Continued from 809C GARAGE: Is detached from the house and locked at all times. There is a freezer and a fridge full of extra food in it. LPA’s saw emergency water accessible laundry supplies, disinfectant, cleaning supplies and facility has a sufficient amount of Personal Protective Equipment (PPE) The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 23, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.