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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001407
Report Date: 12/06/2024
Date Signed: 12/06/2024 12:56:52 PM

Document Has Been Signed on 12/06/2024 12:56 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:EMERALD COURTFACILITY NUMBER:
306001407
ADMINISTRATOR/
DIRECTOR:		DAIZEL C GASPERIANFACILITY TYPE:
740
ADDRESS:1731 MEDICAL CENTERTELEPHONE:
(714) 778-5100
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 299TOTAL ENROLLED CHILDREN: 0CENSUS: 263DATE:
12/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Kathleen PanganibanTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Samer Haddadin made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff and later met with Assistant Executive Director (AED) Kathleen Panganiban and explained the reason for the visit. LPA, along with AED toured the facility and observed the following:

Facility consists of two separate buildings: the main building with the administrative offices is called Emerald and has three stories, building 2 is called Sapphire and has 2 stories. Facility has a memory care unit which is in building 1 on the first floor. LPA tested the memory care in-room trigger alarm and it was operational with response time of .40 seconds. LPA observed the delayed egress exit doors are operational.

LPA observed the kitchen was clean and organized, no mold or mildew seen. 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 and AED toured building 1. LPA observed all stairwells had emergency evacuation chairs. LPA observed all the hallways and stairwells were free of obstacles and or tripping hazards. LPA observed medications were kept secured in the med room inside of medication carts. LPA observed all fire extinguishers are fully charged with last inspection date of July 2024.

LPA toured building 2. LPA observed all hallways and stairwells were free of obstacles and hazards. LPA observed emergency evacuation chairs in the stairwells. All resident rooms observed to have all required components. LPA observed the common restrooms are clean and operational with hygiene supplies. LPA tested water temperature which was 117.- degree Fahrenheit and was within regulatory requirement.

LPA, 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. Smoke detectors and fire alarm system were tested on November 11th, 2024 by third-party company (Cal Building System) and no discrepancies on the report provided by Cal Building. (...CONTINUE 809D...)

Alisa OrtizTELEPHONE: (714) 703-2855
Samer HaddadinTELEPHONE: (714) 790-2096
DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: EMERALD COURT
FACILITY NUMBER: 306001407
VISIT DATE: 12/06/2024
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LPA observed required department postings throughout the facility, however, LPA did not see pub-475 department poster.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. An exit interview with conducted and a copy of this report was provided to the AED.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Samer HaddadinTELEPHONE: (714) 790-2096
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC809 (FAS) - (06/04)
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