Walnut Senior Home III

Type of visit: Required - 1 Year

On 3/25/2026 Licensing Program Analyst (LPA) LaVette Farlow, arrived unannounced at Walnut Senior Home III, to conduct an annual inspections. LPA was greeted by Caregiver Maria Santiago and granted entry into the facility. Maria notified Licensee, Gulvarg Kaur of LPA's arrival. LPA introduced self and stated purpose of the visit. The facility is licensed to house (6) non-ambulatory residents and hospice waiver/granted for six (6) residents. LPA toured the facility inside and outside and observed the following: Physical Plant: Facility is a one story house with (4) resident bedrooms, (2) resident bathrooms inside the facility and a third bathroom outside, office/staff room, living room, dining area, kitchen, pantry, backyard, and attached garage. LPA observed the facility's temperatures to be comfortable and measured at 75 degrees Fahrenheit. LPA observed the hot water temperature in the bathrooms and residents bathrooms. The water temperature in the residents bathroom and common area bathrooms measured at 104.8, 106.6 and 110.6, which is within regulations. LPA observed bathrooms and found that showers and toilets are operable. Each bathroom contained adequate amounts of hygiene supplies and paper products. LPA observed that linens and hygiene items are enough for residents in care. Each resident room included lamps, night-lights dresser drawers, bedding and chairs and appropriate lighting to ensure residents comfort and safety. The facility is equipped with smoke alarms and carbon monoxide detectors. The facility maintains and conducts fire drills and earthquake drills quarterly. Last drill completed in 12/2025. No abnormal notes (LIC809C Continued) made. Fire Extinguishers were observed throughout the facility. Fire Extinguishers were last inspected November 14, 2025. Food Service: Nonperishable and perishable food items observed were sufficient for number of residents in care. Food is being prepared and stored properly. Facility offers a variety of food options and snacks for residents. Staff maintain a food menu which is updated on a monthly basis. Care & Supervision: The facility maintain a sufficient number of staff for care of residents 24 hour and 7 days a week. Facility keeps, toxins, sharps, and other hazardous items secured and inaccessible to residents in care and stored in a closets throughout the facility. Record Review and Resident/Staff Files: LPA reviewed records for three (3) residents files currently living at the facility. Resident records are complete with updated physician reports, Needs and Services Plans, Admission Agreement, and Emergency Contact sheet. LPA observed one residents physician report was expired, but Licensee has maintained constant email contact with InnovAge to request updated report. LPA additionally reviewed three (3) staff files and three (3) out of (3) staff records reflect current CPR/First Aid Certification, Criminal Record Clearance, Health Screening Report, and TB test. All file were available for review and complete. Administration: Disaster Plan, Ombudsman poster, Administrator Certificate, and facility license are posted in a prominent place. Emergency Disaster Plan is current. Facility files are maintained in secure locations in the facility. Medication/Medical Related Services: LPA observed that the residents' medication is centrally stored and locked in the staff office. LPA observed that the Licensee did not updated and maintained the residents centrally stored log. LPA observed an initial for a medication that is no longer being dispensed or stored for 1 out of 3 residents. A deficiency cited. Based on observations, one deficiency cited per Title 22, California Code of Regulations. An exit interview was conducted and copy of this report LIC809, LIC809C, LIC809D, and appeal right reviewed and discussed, then provided to Licensee, Gulvarg Kaur.the state’s words, verbatim · CDSS document, Mar 25, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaVette Farlow, arrived unannounced at Walnut Senior Home III, to conduct an annual inspections. LPA was greeted by licensee, Gulvarg Kaur. LPA introduced self and stated purpose of the visit. The facility is licensed to house (6) non-ambulatory residents and hospice waiver/granted for six (6) residents. LPA toured the facility inside and outside and observed the following: Physical Plant: Facility is a one story house with (4) resident bedrooms, (2) resident bathrooms, office/staff room, living room, dining area, kitchen, pantry, backyard, and attached garage. LPA observed the facility's temperatures to be comfortable and measured at 75 degrees Fahrenheit. LPA observed the hot water temperature in the kitchen, common area bathrooms and residents bathrooms. The water temperature in the residents bathroom and common area bathrooms measured at 108.5, and 108, which is within regulations. LPA observed bathrooms and found that showers and toilets are operable. Each bathroom contained adequate amounts of hand hygiene and paper products. LPA observed that linens and hygiene items are enough for residents in care. Each resident room included lamps, night-lights dresser drawers, bedding and chairs and appropriate lighting to ensure residents comfort and safety. The facility is equipped with smoke alarms and carbon monoxide detectors. The facility maintains and conducts fire drills and earthquake drills quarterly. Last drill completed in 3/2025. No abnormal notes (LIC809C Continued) made. Fire Extinguishers were observed throughout the facility. Fire Extinguishers were last inspected November 2024. Food Service: Nonperishable and perishable food items observed were sufficient for number of residents in care. Food is being prepared and stored properly. Facility offers a variety of food options and snacks for residents. Staff maintain a food menu which is updated on a monthly basis. Care & Supervision: Facility keeps, toxins, sharps, and other hazardous items secured and inaccessible to residents in care and stored in a closets throughout the facility. Record Review and Resident/Staff Files: LPA reviewed records for three (3) residents files currently living at the facility. Resident records are complete with updated physician reports, Needs and Services Plans, Admission Agreement, and Emergency Contact sheet. LPA additionally reviewed three (3) staff files and three (3) out of (3) staff records reflect current CPR/First Aid Certification, Criminal Record Clearance, Health Screening Report, and TB test. Administration: Disaster Plan, Ombudsman poster, Administrator Certificate, and facility license are posted in a prominent place. Emergency Disaster Plan is current. Facility files are maintained in secure locations in the facility. Medication/Medical Related Services: LPA observed that the residents' medication is centrally stored and locked in the staff office. LPA observed that 1 out of 3 resident MAR was missing medication or not properly logged for 2 prescriptions. A deficiency was cited. Based on observations, one deficiency cited per Title 22, California Code of Regulations. An exit interview was conducted and copy of this report reviewed and discussed, then provided to Administrator, Gulvarg Kaur.the state’s words, verbatim · CDSS document, May 7, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michelle Echeverria , arrived at Walnut Senior Home III, to conduct an announced Pre-Licensing visit for licensure. LPA was greeted by licensee, Gulvarg Kaur. LPA introduced self and stated purpose of the visit. LIC200 application was submitted on 11/17/23 for (6) non-ambulatory residents. Fire Safety Inspection clearance was granted for (6) non-ambulatory residents on 12/19/23. LPA toured the facility inside and outside and observed the following: Structure: Facility is a one story house with (4) resident bedrooms, (2) resident bathrooms, office/staff room, living room, dining area, kitchen, pantry, backyard, and attached garage. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire house. Bedrooms: Two bedrooms accommodates two non-ambulatory residents in each room, and two bedrooms across the hallway bathroom accommodates one non-ambulatory resident in each room. Bathrooms: The resident bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives, sharps, detergent, and chemicals are stored in locked cabinets/office. There was a pantry stocked with non-perishable food and perishable food found in the refrigerator. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. Water tested in the bathroom faucet measured at 106.6 degrees fahrenheit. A functional washer and dryer are located inside the garage. Living/Family room: There was a furnished living room with reading books and a tv observed. Linens and Hygiene Supplies: An adequate supply of linens and hygiene supplies stored in a closet. Yards/Outside: A self-latching handle gate on the left side of the house that leads into the backyard. There are no firearms, ammunition, swimming pool or bodies of water observed. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch, visiting rules, and personal rights were observed posted by the entrance. General items: The smoke and carbon monoxide detectors were tested and are operable. There was two fully charged fire extinguishers observed. Resident/Staff records stored inside the locked office. First Aid kit with required components, and a locked area for medication storage was observed. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22. Based on the observations and evaluation of the facility this date, the facility is ready for licensure. LPA completed COMP III with the Licensee at the conclusion of the inspection. Licensee will be notified once facility is licensed. An exit interview was conducted, and this report was discussed and provided to licensee, Gulvarg Kaur.the state’s words, verbatim · CDSS document, Apr 10, 2024