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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001407
Report Date: 01/25/2024
Date Signed: 01/25/2024 04:09:01 PM


Document Has Been Signed on 01/25/2024 04:09 PM - 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:EMERALD COURTFACILITY NUMBER:
306001407
ADMINISTRATOR:DAIZEL C GASPERIANFACILITY TYPE:
740
ADDRESS:1731 MEDICAL CENTERTELEPHONE:
(714) 778-5100
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:299CENSUS: 240DATE:
01/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Assistant Executive Director, Kathleen Panganiban
Environmental Service Director, Pablo Gonzales		TIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Claudia Gutierrez made a unannounced case management visit for the purpose of following-up regarding facility's new fire clearance. LPA met with Assistant Executive Director (AED) Kathleen Panganiban and Environmental Services Director (ESD) Pablo Gonzales, and explained the purpose of the inspection. Fire clearance was updated to include a memory care unit with delayed egress and a capacity increase. New fire clearance was approved by a fire inspector of Anaheim Fire & Safety on 01/18/2024. Capacity was increased to 299, of which 259 may be non-ambulatory, and 40 bedridden. Special conditions noted, “Bedridden on first floor only.” Facility currently has a hospice waiver for 40 residents. LPA, AED, and ESD conducted a tour of the premises and memory care. The memory care unit is located on the first floor of the main building and consists of 16 resident bedrooms, one dining room, one living room, and an outdoor garden. LPA observed residents in memory care engaging in an arts and crafts activity. Delayed egress was tested and observed to be operable.

Based on observation made during today's inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024
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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