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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005159
Report Date: 09/17/2025
Date Signed: 09/30/2025 01:30:16 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/15/2025 and conducted by Evaluator Hanna Gough
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250915160323
FACILITY NAME:EMERYWOOD BOARD & CARE HOMEFACILITY NUMBER:
306005159
ADMINISTRATOR:HERNANDEZ, MARISA CFACILITY TYPE:
735
ADDRESS:8522 EMERYWOOD DRIVETELEPHONE:
(714) 290-3809
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:6CENSUS: 6DATE:
09/17/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Chris MooreTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff is locking refrigerator.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Gough arrived at the facility for the purpose of investigating the above mentioned allegation. LPA was greeted and granted entry by staff. LPA spoke with Administrator (AD) Marisa Hernandez over the phone and discussed the purpose of the visit. Caregiver (CG) Chris Moore assisted LPA with the investigation and AD assisted by phone.

The investigation into the allegations Staff is locking refrigerator revealed the following: LPA observed the inside fridge to be stocked with milk, salad dressing, condiments, and a vegetable tray. The unlocked pantry had cereal, peanut butter, bread, and granola bars. LPA observed the locked pantry and locked fridge in the garage to have an adequate two-day perishable and seven day non-perishable food supply needing to be opened by staff with a key. LPA observed the menu for the week of September 15, 2025 through September 21, 2025, and observed the food on the menu to be in the locked pantry and fridge.
Continue on 9099-C
***This is an amended report***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 22-AS-20250915160323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: EMERYWOOD BOARD & CARE HOME
FACILITY NUMBER: 306005159
VISIT DATE: 09/17/2025
NARRATIVE
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During interviews it was revealed that 3 of 3 staff informed LPA that the indoor fridge and pantry are accessible and clients can grab what they want, when they want. 3 of 3 staff informed LPA that the locked pantry and fridge are due to clients who over indulge.

During the investigation LPA observed S1 transferring food to the unlocked pantry and fridge located in the kitchen.

Based on observations made, information gathered and interviews conducted during the investigation, the preponderance of evidence standard has been met, there fore the above allegation is deemed SUBSTANTIATED. California Code of Regulations, Title 22 Division 6 is being cited on the attached LIC9099D.

An exit interview was conducted with CG Chris Moore and AD Marisa Hernandez and a copy of this report, LIC9099-D and appeal rights were left at the facility.

***This is an amended report***

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250915160323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EMERYWOOD BOARD & CARE HOME
FACILITY NUMBER: 306005159
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2025
Section Cited
CCR
80072(a)(3)
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80072 (a)(3) Personal Rights
(3) …Including but not limited to: interference with the daily living functions, including eating…
This requirement was not met as evidence by: LPA observed the accessible fridge and pantry to be
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LPA observed staff moving food from the locked pantry and fridge into the kitchen making food accessible to clients in care during the investigation. Licensee stated they will do an in service with staff regarding accessible food to clients in care to LPA by 9/19/2025.
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stocked with minimal items with the majority of the food being in a locked pantry and a locked fridge in the garage.
This poses an immediate health, safety or personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3