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Inspection visit

Follow-up on corrections

WALNUT GARDEN IIILicense 1958502465 citations on this visit
5 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Valeria Conway conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control # 29-AS-20240328095338). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation unrelated to the complaint. During today’s visit, LPA met with Administrator Izhak Illouz and Licensee Arlene Ceballos and explained the reason for the visit. During initial visit, LPA conducted a tour of the physical plant. At 10:28 a.m., LPA requested to review facility files, employee’s roster and residents’ files. Additionally, at 10:45 a.m., LPA obtained and reviewed copies of pertinent documentation relevant to the investigation. Between 11:20 a.m. and 12:54 p.m., LPA conducted interviews with facility staff, Administrator, and residents. During today’s visit, the LPA conducted a brief physical plant tour, to ensure there are no health and safety concerns. During the Department’s investigation, the following deficiencies were observed: A review of the staff schedule for March and April 2024 was conducted to assess the allocation and coverage of staff. The schedule was organized into three columns. Each column detailed the coverage for three of the facilities operated by the Licensee, however, shift schedule was not noted. Interviews with the administrator indicate that the facility provides appropriate care for residents during the night shift. According to the administrator, staff conducts constant checks on residents throughout the night. Continued on LIC 9099-C Continued from LIC 9099-C The facility did not submit a Special Incident Report (SIR) to Community Care Licensing (CCL) to notify that Resident #1 (R1) sustained a fall resulting in a fractured wrist on 03/27/2024. Licensee did not update R1’s appraisal needs and services plan to document R1’s change of condition which included behavioral issues and aggression which required medication adjustment. A review of R1’s Physician Report revealed the report was not complete as the physician’s signature and date were missing and the section for authorization for release of medical information was blank. During the initial visit on 04/03/2024, LPA observations and record reviewed revealed that Staff #1 (S1) currently working at the facility however S1 is not fingerprint cleared nor associated to the facility. Furthermore, a review of Guardian system and the staff roster revealed that Staff #2 (S2) is fingerprinted but not associated to the above facility. Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 809-D) Exit interview conducted. Citation issued. A Copy of report and appeal rights provided

Citations

5 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87211(a)(1)(B)Type B

    87211(a)(1)(B) Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency and to the person responsible... events specified in (A) through (D) below….. (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision.This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Licensee did not submit an incident report when R1 fell and fractured wrist, which posed a potential health and safety risk to residents in care.

  • 87355(e)(1)Type A

    87355: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:This requierment is not met as evidence by: Based on records reviewed staff #1 has been working at the facility but does not have backround clearance and it is not associated to the facilit, which poses and immediate safety risk to residents in care

  • 87411(a)Type A

    Personnel Requirements - General(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on records review and interviews, the licensee did not comply with the section cited above. There is no staff coverage from 7:00pm to 7:00am, which poses an immediate health and safety risk to residents in care.

  • 87458(a)Type B

    87458(a) Medical Assessment(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional ... kept in the resident's record. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. R1’s medical assessment was missing physician signature and date, and the section for authorization for release of medical information was blank, which posed a potential health and safety risk to residents in care.

  • 87463(b)Type B

    87463(b) Reappraisals (b) The reappraisal shall document significant changes in the resident's physical, ..., including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Licensee did not update R1’s appraisal needs and services plan to document R1’s change of condition which included behavioral issues and aggression which required medication adjustment, which posed a potential health and safety risk to residents in care.

FAQ · About this visit

Common questions about this visit

What happened during the January 14, 2025 inspection of WALNUT GARDEN III?

This was a other inspection of WALNUT GARDEN III on January 14, 2025. 5 citations were issued: 2 Type A (serious) and 3 Type B.

Were any citations issued to WALNUT GARDEN III on January 14, 2025?

Yes, 5 citations were issued (2 Type A, 3 Type B). The first citation was for: "87211(a)(1)(B) Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports...(1) A writte..."

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.