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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001407
Report Date: 10/21/2022
Date Signed: 10/21/2022 04:07:57 PM


Document Has Been Signed on 10/21/2022 04:07 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:139CENSUS: 258DATE:
10/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:47 PM
MET WITH:Daizel GasperianTIME COMPLETED:
04:30 PM
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
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA met with Executive Director (ED) Daizel Gasperian. LPA explained the reason for the visit. Assisted Living Director (ALD) Kathleen Panganiban was also present. LPA, ED and ALD toured the facility. Facility consists of 2 buildings, The main building with the administrative offices is called Emerald and has 3 stories, building 2 is called Sapphire and has 2 stories. Facility has a memory care unit in building 1 on the first floor. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand. LPA observed emergency food and water stored in a closet next to the kitchen. LPA observed the temperature logs for the refrigerators and freezers are posted on the kitchen wall next to the door leading to the Sapphire dining room. LPA, ED and ALD toured building 1. LPA observed all stairwells had emergency evacuation chairs. LPA observed all of the hallways and stairwells were free of obstacles and hazards. LPA observed medications were kept secured in the med room inside of medication carts. LPA observed hand sanitizing stations throughout building one. LPA observed all fire extinguishers are fully charged. LPA, ED and ALD toured building 2. LPA observed all hallways and stairwells were free of obstacles and hazards. LPA observed emergency evacuation chairs in the stairwells. LPA observed resident rooms had the required furnishings. LPA observed the common restrooms are clean and operational. LPA observed all staff wearing masks. LPA, ED and ALD toured the outside of the facility. No bodies of water observed outside of the facility. LPA did not observe any obstacles or hazards outside of the facility. LPA, ED and ALD toured the memory care unit. LPA observed the delayed egress exit doors are operational. No obstacles or hazards observed in the memory care unit. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. LPA consulted with ED concerning continued mitigation requirements and reporting requirements. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1