306001407-7-14-2022-22-AS-LADS-CGJT9Z-20220721143243

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306001407
Report Date: 07/14/2022
Date Signed: 07/14/2022 12:10:35 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
07/07/2022 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220707135905

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: 135	DATE:	07/14/2022
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Daizel Gasperian		TIME COMPLETED:	12:18 PM

ALLEGATION(S):

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Facility is not providing care to resident.
Facility is not repairing resident's light in room.

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 allegations listed above. LPA was greeted and granted entry by staff. LPA met with Executive Director (ED) Daizel Gasperian and AssistedLliving Director Kathleen Panganiban. LPA explained the reason for the visit. The investigation into the allegations revealed the following; It was alleged that Resident 1 (R1) was not checked on by the facility from 7/3/22 to 7/7/22. Through a record review it was shown that R1 reported to the facility from 7/3/22 to 7/7/22 that they were doing ok and did not require assistance. The only issue in facility records concerning R1 was the Responsible Party (RP) taking R1 to the hospital for an illness on 7/13/22. R1 is still at the hospital for issues unrelated to Covid-19. Facility staff reported that they spoke to R1 on July 3 through July 12 and R1 did not ask for or require extra assistance. RP verified the staff reports. It was alleged that R1 requested assistance with a telehealth appointment utilizing video chat. Facility staff reported that no requests came in for assistance with a telehealth appointment from 7/3/22 to 7/13/22, this was verified by the RP. It was alleged that the facility had not repaired a light in R1’s room.
Continued.

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: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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-20220707135905

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: 07/14/2022

NARRATIVE

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ED reported there are no maintenance requests for R1’s room. RP verified this report. LPA observed each light in R1’s room is working. Based on evidence gathered through a review of records and interviews the allegations are deemed UNFOUNDED, meaning the allegations are 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: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

LIC9099 (FAS) - (06/04)

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