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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201167
Report Date: 11/12/2025
Date Signed: 11/12/2025 02:02:32 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, 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
11/30/2023 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20231130153304
FACILITY NAME:EMERALD VALLEYFACILITY NUMBER:
019201167
ADMINISTRATOR:ESPINOZA, MARISSA KFACILITY TYPE:
740
ADDRESS:7601 AMADOR VALLEY ROADTELEPHONE:
(925) 361-0913
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:80CENSUS: 72DATE:
11/12/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Janelle Douglas, Executive Director TIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Staff mismanaged resident medication
Staff speak inappropriately to residents in care
INVESTIGATION FINDINGS:
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On 11/12/2025, starting at 12:30 PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver findings for the above allegations. LPAs met with Executive Director, Janelle Douglas, and explained the purpose of the visit.

Allegation: Staff mismanaged resident medication- Unsubstantiated.

During the course of the investigation, LPA conducted staff and residents' interviews. LPA reviewed a sample of 6 residents' files, including but not limited to Physician's Report, Care Plan, Centrally Stored Medication, and Medication Administration Record (MAR).


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

DATE: 11/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025
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 2
Control Number 15-AS-20231130153304
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: 11/12/2025
NARRATIVE
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It was alleged that staff mismanaged resident's medication; however, based on the investigation, including interviews, record reviews, and observation, there was insufficient evidence to support the allegation that staff mismanaged a resident’s medication. Medication administration records and staff documentation were consistent with prescribed orders, and no discrepancies were observed during the review. Staff demonstrated appropriate medication handling and administration procedures in accordance with facility policy and regulatory requirements.

Allegation: Staff speak inappropriately to residents in care

During the course of the investigation, LPA conducted 6 staff and 6 residents' interviews.

It was alleged that staff spoke inappropriately to residents in care. Based on the investigation, including interviews with 5 staff, 6 residents, and a review of relevant records, there was insufficient evidence to support the allegation that staff spoke inappropriately to residents in care. Residents interviewed did not report instances of verbal mistreatment, and no witnesses or documentation corroborated the allegation. Staff demonstrated appropriate and respectful communication with residents during observations.

Based upon interviews conducted and records reviewed, LPA has investigated the above allegations and found that it is Unsubstantiated. A finding that the complaint allegation/s are Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview is conducted, and a copy of this report is provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2