Walnut Senior Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaVette Farlow arrived unannounced to conduct the required annual visit to the facility. LPA were greeted and granted access into the facility by Caregiver, Roselina Mardiana and introduced self and stated purpose of the visit. LPA asked Roselina to informed the Administrator of LPA's arrival. The facility has 4 bedrooms, 1 staff room, 2 bathrooms, kitchen, dining area, family room, living room, laundry area in the garage, attached garage, and backyard. LPA completed a walk through of facility, review of records, and conducted a random audit of the medication. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 76 degrees Fahrenheit. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting. LPA inspected client bathrooms; bathrooms were clean and appliances were found functional. LPA observed that facility has a sufficient supply of hygiene items for residents in care. Water temperatures tested at 112.9 and 118.7 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms and charged fire extinguisher. LPA observed poster on display for personal rights, and disaster plans were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept in secure cabinets, inaccessible to clients. At 10:15 AM LPA was completing a tour of the kitchen and observed in the drawer a pair of scissors and a knife/box cutter. LPA advised caregiver to secure the items. A deficiency cited. There was a designated storage space for client/staff files. Medications and first aid kit were in secure cabinets and inaccessible to clients. There are no firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions. Food Service: LPA observed that the facility has a sufficient supply of perishable and non-perishable items. The facility has sufficient supply of dishes, cups, and utensils were also stored properly. Emergency food and water were observed. Yards/Outside: LPA observed one shaded patio, a side gate with self-latching handle on the left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. LPA observed fruit and vegetables trees in the backyard. Record Review: LPA reviewed Administrator and 2 staff files for First Aid/CPR certification, criminal record clearance, training, health screenings and TB test. LPA reviewed 3 residents files for admissions agreements, pre-admissions appraisals, physician's reports, and care plans. Personnel records and residents file appeared to be complete and in order. One deficiency was cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D and Appeals Rights were discussed and copies were provided to Administrator, Gulvarg Maya Kaur.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) LaVette Farlow and Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPAs were greeted and granted access into the facility by Caregiver Jeffrey De Jose, and introduced ourselves and stated purpose of the visit. LPAs asked that the administrator be informed of our arrival. The facility has 4 bedrooms, 2 bathrooms, kitchen, dining area, family room, living room, laundry area in the garage, attached garage, and backyard. LPAs completed a walk through of facility and review of records. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 77 degrees Fahrenheit. LPAs inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting. LPAs observed that there were 5 missing chair in residents room. A deficiency issued. LPAs inspected client bathrooms; bathrooms were clean and appliances were found functional. LPAs observed that facility did not have sufficient supply of hygiene items for residents in care. A deficiency was issued. Water temperatures tested at 108.3 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms and charged fire extinguisher. LPAs observed poster on display for personal rights, and disaster plans were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept in secure cabinets, inaccessible to clients. There was a designated storage space for client/staff files. Medications and first aid kit were in secure cabinets and inaccessible to clients. There are no firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions. Food Service: LPAs observed that the facility did not have a sufficient supply of perishable and non-perishable items. A deficiency was issued. The facility has sufficient supply of dishes, cups, and utensils were also stored properly. Emergency food and water were observed. Yards/Outside: LPAs observed one shaded patio, a side gate with self-latching handle on the left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Record Review: LPAs reviewed Administrator and staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. LPAs reviewed client files for admissions agreements, pre-admissions appraisals, physician's reports, and care plans. LPAs observed incomplete resident record which included issues with the physician report, TB test, and appraisal. A deficiency was issued. LPAs observed staff personnel file missing general training and medical training. Deficiency issued. Deficiencies were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D and Appeals Rights were discussed and copies were provided to Administrator, Gulvarg Kaur.the state’s words, verbatim · CDSS document, Oct 14, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Walnut Senior Home II unannounced to conduct an Annual Inspection of the facility. LPA was greeted by Caregiver/Staff, Jeffrey De Jose, then granted entry. LPA was then greeted by Administrator, Gulvarg Kaur who accompanied LPA on a walk through the facility. The facility is a Residential Care Facility for the Elderly. The facility is approved for six, (6) non-ambulatory residents, 1 bedridden and has a Hospice Waiver in place for four, (4) residents. The facility is comprised of 4 Resident Rooms, 1 Staff Room, 1 Office, Living/Dining Room, Kitchen, 2 Bathrooms, Backyard and attached garage. Personnel Records/Training/and Staffing- LPA reviewed three, (3) employee records for first aid certification, fingerprint/criminal background clearances, personnel/job application, health screening, TB test results, employee rights and training verification, and current administrator certifications. LPA observed that all staff records were complete with all required annual documents. Resident Rooms - Each resident bedroom accommodate both ambulatory and non-ambulatory residents. All resident bedrooms were adequately furnished with bed/mattress, chair, large closets, appropriate linens, adequate lighting, and an operational smoke/carbon monoxide alarms. Bathrooms: All bathrooms have a functional toilets, wash basins, and showers with an adequate supply of towels, toilet paper, and toiletries. Hand rails and non-slip grip mats were observed accessible for use. Bathrooms were observed to be clean and orderly. Water temperature tested and found to be within regulatory limits. Please see LIC809-C Resident Records/Incident Reports/Personal Rights/Residents with Special Needs/Incidental Medial and Dental- LPA reviewed three, (3) resident records for admissions agreements, medical assessments, annual TB test results, consent forms, identification/emergency information, pre-appraisals, needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed completed documents in each of the resident files. Food Service- LPA observed the refrigerator to have adequate amounts of food for the capacity of residents in care. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables food on hand. LPA observed a weekly food menu posted on the refrigerator; which offered a variety of meals and snacks for residents in care. Food prep areas are clean and free of clutter. Clean and properly stored dishes and utensils were also observed. Sharp objects are located within a lock box inaccessible to residents. General: Disaster drills are completed every three months. Last fire/disaster drill was completed September 2023. LPA observed a fully charged fire extinguisher last inspected July 2023. No deficiencies observed during today's visit. An exit interview was conducted where this report was reviewed discussed then provided to Administrator Gulvarg Kaur.the state’s words, verbatim · CDSS document, Oct 16, 2023