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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001407
Report Date: 10/12/2022
Date Signed: 10/12/2022 02:52:29 PM


Document Has Been Signed on 10/12/2022 02:52 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: 255DATE:
10/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Daizel GasperianTIME COMPLETED:
03:05 PM
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On today’s date, Licensing Program Analysts (LPA) LPA Edward Tapia and LPA Joseph Alejandre conducted a Case Management visit with the purpose to issue a Civil Penalty assessment. LPAs met with Executive Director Daizel Gasperian. LPAs explained the purpose of the visit. On 09/14/2022, a type A violation was issued to the facility (see LIC809 & LIC809-D 09/14/2022) for violation of CCR 87518(a). At the time of that visit no Civil Penalty was issued. Today’s visit is to issue the Civil Penalty for the above violation. The previous violation was cited per Title 22 Division 6 of the California Code of Regulations.

Civil penalty in the amount of $500 is being assessed. See LIC421BG.

An exit interview was conducted with Executive Director Daizel Gasperian, and a copy of this report and Civil Penalty was provided at exit.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward TapiaTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022
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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