Facility Evaluation Report

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.