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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001407
Report Date: 09/22/2022
Date Signed: 09/22/2022 01:25:56 PM


Document Has Been Signed on 09/22/2022 01:25 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: 0DATE:
09/22/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Daizel Gasperian, Lisa O’Nea, Ed Ward, Joel GoldmanTIME COMPLETED:
11:00 AM
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At this informal conference held virtually via Teams, present were Regional Manager Marina Stanic, Licensing Program Manager (LPM) Armando Lucero, Licensing Program Analyst (LPA) Joseph Alejandre, General Counsel Lisa O’Neal, Vice President of Operations Ed Ward, Executive Director Daizel Gasperian and Counsel Joel Goldman.

The following was discussed:

· Case Management visit on 9/14/22

· Capacity of facility

· Independent living residents

Licensee agreed to:

· File a new application (LIC 200) to reflect increased capacity for all residents by 9/26/22

· Provide an updated facility sketch floor plan (LIC 999)

· Provide an updated plan of operation and the admission agreement by 9/30/22

The plan of operation will delineate process of changing status from more independent to less independent residents and having residents status correctly identified and on record at all times.

Discussion and outcome of this meeting satisfies as meeting the plan of correction for citation issued on 9/14/22.

An exit interview was conducted, and a copy of the report was provided via email. The Executive Director agreed to acknowledge receipt of this report via email.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022
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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