Pre-licensing visit·August 21, 2025

Licensing Program Analyst (LPA) LaVette Farlow, arrived at Walnut Senior Home 1, to conduct an announced Pre-Licensing visit for licensure. LPA was greeted by Licensee, Gulvarg "Maya" Kaur. LPA introduced self and stated purpose of the visit. LIC200 application was submitted on 06/01/2025 for (5) non-ambulatory residents, and (1) bedridden. Fire Safety Inspection clearance was granted for (5) non-ambulatory residents, and (1) bedridden on 07/29/25. LPA toured the facility inside and outside and observed the following: Structure: Facility is a one story house with (4) resident bedrooms, (1) staff bedroom, (2) bathrooms, office space and game area, living room, dining area, kitchen, washer and dryer in the garage, 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. The temperature reading was 74 degrees Fahrenheit. Bedrooms: Two bedrooms accommodates two non-ambulatory residents in each room, and one private bedrooms to accommodates one non-ambulatory resident, one shared room to accommodate one bedridden resident and one non-ambulatory resident. Bathrooms: The 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 compartments. 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 110.1, 107.2, and 106.1 degrees Fahrenheit. A functional washer and dryer are located inside the garage. Living/Family room: There was a furnished living room with 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 right 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, CCL complaint poster, and visiting policy were observed posted by the hallway. General items: The smoke and carbon monoxide detectors were tested and are operable. There was two fully charged fire extinguisher observed. Resident/Staff records stored inside the office area and secured. First Aid kit with required components, and a locked compartment for medication storage was observed. Emergency kits were observed inside the garage. The facility has a functioning telephone and line. 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 "Maya" Kaur.