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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001407
Report Date: 04/15/2021
Date Signed: 04/15/2021 05:59:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:EMERALD COURTFACILITY NUMBER:
306001407
ADMINISTRATOR:PATRICIA GIRAY-GUSTINFACILITY TYPE:
740
ADDRESS:1731 MEDICAL CENTERTELEPHONE:
(714) 778-5100
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:123CENSUS: 110DATE:
04/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Patricia GustinTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to inspect the new memory care unit at the facility. Facility has already provided the memory care plan of operation and facility sketch. New memory care unit at the facility has already been inspected by the Anaheim Fire & Rescue. Fire clearance granted on 4/14/2021. LPA was greeted and granted entry by Administrator Patricia Giray-Gustin. LPA observed the check in station in the lobby of the facility where visitors check in and temperatures are taken. LPA observed all staff wearing masks. LPA observed hand sanitizing stations throughout the facility. LPA observed residents engaged in social distancing activities (residents playing Nintendo Wii bowling). Administrator and LPA toured the memory care unit. Memory care unit is secured by a locked door which requires a security code to enter and exit. Fire exits are delayed egress. Memory Care unit has a secured patio for residents with a shaded seating area. LPA inspected all 16 memory care rooms. All rooms have enough space to accommodate resident's belongings. All rooms and bathrooms have working call light system activated by a pull cord. All resident rooms and bathrooms were clean and operational. Memory care unit has a dining area for the residents that can also be used as an activity area. There is also a large room for residents to sit or watch TV. The office, staff break room and laundry room (in the memory care unit) are kept locked and inaccessible to residents. LPA did not observe any hazards or obstacles in the memory care unit or memory care unit patio. Memory care unit is ready for operation. LPA advised Administrator to notify Agency when they admit their first resident. LPA advised new license reflecting the memory care unit and increased capacity will be mailed to the facility. Exit interview conducted and a copy of this report provided to the administrator via email. Administrator agreed to return a signed copy of the report to the LPA. Email return read receipt verifies report was sent and received by Administrator.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
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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