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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306001407
Report Date:
12/14/2021
Date Signed:
12/14/2021 12:58:05 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 COURT
FACILITY NUMBER:
306001407
ADMINISTRATOR:
DAIZEL C GASPERIAN
FACILITY TYPE:
740
ADDRESS:
1731 MEDICAL CENTER
TELEPHONE:
(714) 778-5100
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92801
CAPACITY:
139
CENSUS:
130
DATE:
12/14/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:16 PM
MET WITH:
Daizel Gasperian
TIME COMPLETED:
01:16 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry. LPA explained the reason for the visit. LPA and executive director Daizel Gasperian toured the facility. LPA observed Covid-19 signs throughout the facility. LPA observed hand sanitizing stations throughout the facility. LPA observed both entrance points to the building have a sign in station where visitors and staff check in and are screened for temperature and symptoms of Covid-19. LPA did not observe any obstacles or hazards at the facility. Facility has a mitigation plan that has been approved. Facility is following their mitigation plan and has a 30 day supply of PPE. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/14/2021
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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