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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802838
Report Date: 05/14/2022
Date Signed: 05/14/2022 11:08:01 AM

Document Has Been Signed on 05/14/2022 11:08 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:WALNUT VILLA-TELEGRAPH IIFACILITY NUMBER:
197802838
ADMINISTRATOR:HAAS, SCOTTFACILITY TYPE:
740
ADDRESS:13973 TELEGRAPH ROADTELEPHONE:
(562) 777-7200
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY: 6CENSUS: 0DATE:
05/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Celina VazquezTIME COMPLETED:
11:25 AM
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This report supercedes report dated 5/14/2022, which was missing administrator signature.

Licensing Program Analyst/ (LPA) Angelica Rea, conducted an unannounced annual inspection visit at the Walnut Villa - Telegraph II facility. LPA was allowed entry into the facility by Celina Vasquez, Administrator. LPA Rea explained to Ms. Vasquez the purpose of the required 1 year annual inspection visit.

Ms. Vasquez informed LPA that there are no residents residing in Walnut Villa - Telegraph II. LPA toured the facility with Ms. Vasquez.. The residential house is one of three residential homes (on the property) has three bedrooms, two bathrooms, kitchen, dining room, living room.

LPA toured the house and did not observe any residents living in the facility. Ms. Vasquez informed LPA that she faxed and mailed, Monterey Park Office-DSSCC, a letter stating that there are no residents living in the facility, and that the current owners of the facility are planning to renovate the facility for future residents to be admitted. LPA informed Ms. Vasquez to contact DSS-Community Care Licensing prior to beginning any renovations to the facility. Administrator indicated that they want to maintain the license of the facility.

No deficiencies cited. An exit interview was conducted and a copy of this report was provided to Celina Vazquez, Administrator.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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