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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201167
Report Date: 04/23/2025
Date Signed: 04/23/2025 11:09:58 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2023 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20230417152559
FACILITY NAME:EMERALD VALLEYFACILITY NUMBER:
019201167
ADMINISTRATOR:ESPINOZA, MARISSA KFACILITY TYPE:
740
ADDRESS:7601 AMADOR VALLEY ROADTELEPHONE:
(360) 836-4604
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:80CENSUS: 74DATE:
04/23/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marissa Espinoza, Executive Director TIME COMPLETED:
11:20 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was sexually assaulted by staff
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/23/2025 at 10a.m. Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced visit to deliver the finding for the above complaint allegation. LPA met with Executive Director Marissa Espinoza and explained the purpose of the visit.

Allegation: Resident was sexually assaulted by staff- Substantiated

The Department received this complaint alleging that on 1/01/23, S3 escorted R1 to R1’s room and told R1 that R1 was dirty and to undress for a sponge bath, then proceeded to kiss R1’s chest. The RP further stated that R1 informed W1, who in turn filed a local police report, that S3 was charged with “sexual battery, elder adult abuse, dissuading a witness, and another aggravated charge”. In the course of an investigation, the Department obtained and reviewed the Police Report for the subject incident and spoke to facility staff.

Report continued on LIC 9099c...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
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 3
Control Number 15-AS-20230417152559
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: EMERALD VALLEY
FACILITY NUMBER: 019201167
VISIT DATE: 04/23/2025
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
On 4/19/23, LPA Kelly Nguyen interviewed S1, who stated not having knowledge of the incident until receiving a telephone call from S2, stating that S2 was being interviewed by the local Police Department regarding a report received pertaining to S3. S1 stated having immediately contacted the third-party agency from which S3 came from and informed that agency that S3 could not come back to the facility. S1 stated having then contacted family to discuss the situation. On 4/19/23, LPA KN also spoke to S2, who stated that S2 was interviewed by local police pertaining to a report they received alleging that S3 had sexually assaulted a resident. S2 had no knowledge of the incident and informed S1 of the police interview. S2 was aware that S1 contacted the third-party agency and instructed them that S3 could not return to the facility.
On 4/22/23 and 4/24/23, LPA KN attempted to contact S3 but found the only known number was not in operation. At case filing, there was information pertaining to S4, but S4 had already been found to have left the United States, prior to CCLD receiving the case. LPA KN found no contact information for S4.

On 4/26/24, the Department received a copy of the police report pertaining to the incident. It was observed that an officer responded on 1/3/23; and found that S3 had been terminated on that same day. PD interviewed R1 who provided a corroborating statement, and was able to interview S4 who stated having requested S3 to assist with R1 as S3 was escorting 2 residents from the dining room to their rooms. After being in the other resident’s room for approximately 4 minutes, S4 heard a yell come from R1s room. Upon responding, R1 was looking outside of R1’s door but did not disclose any issued to S4. W1 also provided a corroborating statement for the sequence of events. Following a CALICO interview and meeting with S3 on 1/19/23 – whereby S3 admitted to kissing R1’s chest area, the PD believed that S4 had committed sexual battery upon R1. S4 was taken into custody that day.

Based upon information obtained, the Department has investigated this complaint determined that the preponderance of evidence standard has been met. Therefore, the allegation is found to be Substantiated.

Deficiency cited per Title 22, California Code of Regulations and listed on the attached LIC9099D. Failure to submit proof of correction by the due date may result in civil penalties.

Exit interview conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20230417152559
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: EMERALD VALLEY
FACILITY NUMBER: 019201167
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2025
Section Cited
CCR
87468.2(a)(8)
1
2
3
4
5
6
7
87468.2 Additional Personal Rights of Residents in Privately Operated Facilities

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:
(8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse.
1
2
3
4
5
6
7
By POC date, Administrator agrees to review regulation with staff and submit self-certification letter.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on record review and interviews by the Department, Licensee did not comply with the regulation cited above. S4 had committed sexual battery upon R1. S4 was taken into custody that day.
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: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3