<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197803700
Report Date: 10/09/2025
Date Signed: 10/09/2025 04:39:30 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/09/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250509120852
FACILITY NAME:WALNUT VILLAFACILITY NUMBER:
197803700
ADMINISTRATOR:MICKLE, VICKIEFACILITY TYPE:
740
ADDRESS:13975 TELEGRAPH RD.TELEPHONE:
(562) 777-7200
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:20CENSUS: 12DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH: Assistant Administrator Celina VasquezTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not attend to residents in a timely manner
Staff did not ensure a sufficient food supply was available at the facility
Facility shower room does not deliver hot water for resident's use
Staff did not ensure sufficient cleaning supplies were available at the facility to keep the facility clean
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Assistant Administrator Celina Vasquez and explained the reason for the visit.
The initial visit was conducted on 05/15/25 and included the following:
LPA conducted a tour of the facility with Assistant Administrator Celina Vasquez which included kitchen, living room, dining room, front and back side of the facility.
Interviews were conducted with Assistant Administrator Celina Vasquez and telephonically with Administrator Cynthia Padeo.
Chemical Inventory List was submitted and Food Inventory to be submitted.
At today's visit 10/9/2025 Resident's R1- R5 were interviewed , Staff S1- S3 and Assistant Administrator were interviewed.
In regards to the allegation Staff did not attend to residents in a timely manner, based on interviews conducted and information gathered 5 of 5 residents all stated that staff provide great timely medical assistance. Said staff are willing to assist them whenever they are called.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 28-AS-20250509120852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 197803700
VISIT DATE: 10/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Assistant Administrator Celina Vasquez stated that their main goal is patient advocacy. Feels staff responds in a timely manner.
Stated at night they use the pull cord and staff respond quickly. During the day 5 residents on Hospice call for help and they are always assisted.
Administrator stated that always 3 on shift and they will respond right away. Sometimes they may say give me a minute, but they will always take care of the residents.
Staff S1- S3 said they will respond in a reasonable time frame.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation Staff did not ensure a sufficient food supply was available at the facility, based on interviews conducted and tour of the kitchen and food supply on 5/15/25 and 10/9/25 by LPA who observed a sufficient supply of 2 day perishables and 7 day non-perishables which included the following:
Milk, juice, vegetables, yogurt, oatmeal, chicken, ground beef, shrimp, fish, hot dogs, corn, lunch meat, pasta, beans, crackers, Jello, eggs and ice cream.
Staff S1-S3 stated there is enough food today.
Resident's R1- R5 all stated that there is a large supply of food. They get all 3 meals and a snack and can even go back for 2nd's.
LPA observed variety of can foods, and dried goods such as lentils, beans, rice, pasta in the pantry. LPA reviewed the following documents: facility menus, and per facility schedule two staff are assigned to the kitchen throughout the week.
It should also be noted that the allegation Staff do not ensure there is enough food at the facility for residents Complaint Control # 28-AS-20250123120517 previously had Unsubstantiated finding on 1/30/25.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation Facility shower room does not deliver hot water for resident's use, based on interviews conducted and tour of the shower room it was revealed on tours conducted on 5/15/25 and 10/9/25 that there was hot water delivered for residents on both visits.
Assistant Administrator Celina Vasquez stated that showers are 2 to 3x a day and there is hot water and no one has complained.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 28-AS-20250509120852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 197803700
VISIT DATE: 10/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Staff S1-S2 said showers are given 2x a week and they do have hot water.
Administrator stated they always check and there is always hot and cold water.
Resident's R1- R5 said they are assisted with showers each week and there is hot and cold water.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
In regards to the allegation Staff did not ensure sufficient cleaning supplies were available at the facility to keep the facility clean, based on interviews conducted and tour of locked area for chemicals LPA observed on 05/15/25 and 10/9/25 that there was a sufficient supply of chemicals. LPA observed the following:
laundry soap, dishwashing liquid, bleach, cleaner with bleach, toilet paper, paper towels and kitchen bags.
Resident's R1- R5 all stated that the facility is kept clean. Said they always see staff cleaning and always doing laundry.
Stated housekeeping always cleans their room and they have seen them use cleaning sprays.
Administrator stated that they always keep chemicals full and also have a Chemicals Inventory List.
LPA observed the list which included a surplus amount of cleaning supplies.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/09/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250509120852

FACILITY NAME:WALNUT VILLAFACILITY NUMBER:
197803700
ADMINISTRATOR:MICKLE, VICKIEFACILITY TYPE:
740
ADDRESS:13975 TELEGRAPH RD.TELEPHONE:
(562) 777-7200
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:20CENSUS: 13DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH: Assistant Administrator Celina VasquezTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure facility was kept free of hazards
Staff did not ensure a comfortable facility temperature was maintained for residents in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
In regards to the allegation Staff did not ensure facility was kept free of hazards, based on interviews conducted and observation it was revealed on the visit conducted on 5/15/25 that the LPA saw that the facility has overgrown weeds around the house and also that the Facility floorboards are lifted.
Assistant Administrator on the tour of the facility on 05/15/25 with LPA did confirm that there was floorboards lifted and also confirmed that there was overgrown weeds around the house.
Staff S1- S3 along with LPA at today's visit also confirmed that there was overgrown weeds around the house and also that the Facility floorboards are lifted.
Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20250509120852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 197803700
VISIT DATE: 10/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation Staff did not ensure a comfortable facility temperature was maintained for residents in care, based on interviews conducted and information gathered LPA on the initial visit conducted on 5/15/25 observed that the air conditioning unit was not working.
Assistant Administrator confirmed that the air conditioner wasn't working.
Staff S1-S3 all stated that the air conditioner had been down previously.
5 of 5 residents acknowledged that the air conditioner was not in use and was inoperable.
Tour of facility at today's visit 10/09/25 the air conditioner was operable and the facility maintained a comfortable temperature.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20250509120852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 197803700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2025
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
Maintenance and Operation
The facility shall be clean, safe, sanitary and in good repair at all times.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Facility to have the air conditioning unit and the facility floorboards and overgrown weeds in good repair by the POC due date.
Facility has air conditioner operable.
Floorboard to be corrected and weeds to

8
9
10
11
12
13
14
Based on interviews and observation the facility failed to be in good repair at all times with the air conditioning unit not working and also facility floorboards lifted and overgrown weeds around the house which poses a potential risk to the persons health, safety, and personal rights of the persons in care
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6