306001407-1-13-2022-22-AS-MVAO-CG9SZC-20220712141855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306001407
Report Date: 01/13/2022
Date Signed: 01/13/2022 01:08:07 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/12/2022 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220112151111

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: 103	DATE:	01/13/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Daizel Gasperian		TIME COMPLETED:	01:22 PM

ALLEGATION(S):

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Resident was denied visitors due to COVID-19.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA was screened for Covid-19 and granted entry by staff. LPA met with Executive Director Daizel Gasperian and explained the reason for the visit. The investigation into the allegation, resident was denied visitors due to Covid-19, revealed the following. On 1/11/2022 sometime between 3pm and 5pm a visitor (V1) for Resident 1 (R1) was attempting to gain entry to the facility to visit R1. Facility staff inquired about V1's vaccination status. Staff reported that V1 was not vaccinated and would not provide a recent negative test result as required by the California Department of Public Health (CDPH) order dated 12/31/2021 effective 1/7/2022 to 2/7/2022. The order states all visitors who are unvaccinated are eligible to outdoor visitation if they provide a recent (specimen collected in the last two days for a PCR test, one day for an antigen test) negative test for Covid-19. Staff reported they denied entry because V1 informed them they were not vaccinated and would not provide a negative test. V1 verified this information. Staff informed V1 that R1 could leave the facility but they could not visit in the facility unless the requirements of the CDPH order dated 12/31/2021 were followed.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20220112151111

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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
	VISIT DATE: 01/13/2022

NARRATIVE

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It was reported that V1 did not wish to comply with the order. V1 verified this information. R1 did leave the facility with V1 and returned later that day. Even though V1 was denied entry to the facility because they would not comply with the CDPH order dated 12/31/2021 a visit with R1 did take place just not in the facility. The facility staff and management followed the CDPH order dated 12/31/2021 and explained their position to V1. V1 verified this information. Based on the evidence gathered through interviews, a review of the CDPH order dated 12/31/2021 the allegation, Resident was denied visitors due to COVID-19, is deemed UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. 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: 01/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022

LIC9099 (FAS) - (06/04)

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