<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201167
Report Date: 02/19/2026
Date Signed: 02/19/2026 01:18:45 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2025 and conducted by Evaluator Ardalan Gharachorloo
COMPLAINT CONTROL NUMBER: 15-AS-20250813143400
FACILITY NAME:EMERALD VALLEYFACILITY NUMBER:
019201167
ADMINISTRATOR:ESPINOZA, MARISSA KFACILITY TYPE:
740
ADDRESS:7601 AMADOR VALLEY BLVDTELEPHONE:
(925) 361-0913
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:80CENSUS: 72DATE:
02/19/2026
UNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Janelle Douglas, Executive DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not meet a resident's catheter needs while in care
Staff did not provide adequate care and supervision to a resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/19/2026 at 10:26 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to deliver findings in regard to the allegations above. LPA met with Janelle Douglas, Executive Director and explained the purpose of the visit.

Staff did not meet a resident’s catheter needs while in care - Substantiated

LPA reviewed video recordings and email correspondence provided by W1, as well as R1’s charting notes and Needs and Services Plan. LPA also conducted interviews with staff S1–S3 and W1. A review of the submitted video footage in conjunction with charting documentation indicated that R1’s catheter care needs were not consistently met. Documentation and visual evidence showed multiple occasions in which required catheter care was delayed or not provided within appropriate timeframes.

***Continue on 9099C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
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 5
Control Number 15-AS-20250813143400
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: EMERALD VALLEY
FACILITY NUMBER: 019201167
VISIT DATE: 02/19/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
***CONTINUE FROM 9099C***

The review of video footage recorded in different days and times, email correspondence and care notes supports that these lapses occurred for extended periods, which is inconsistent with the level of care outlined in R1’s care plan.The combination of recorded footage, staff interviews, and facility records corroborates that care was not provided as required.

Allegation: Staff did not provide adequate care and supervision to a resident - Substantiated

LPA reviewed R1’s Needs and Services Plan, R1's charting notes, video footage submitted by W1, and conducted interviews with staff S1–S3 and W1. A review of the documentation and recordings showed that staff did not consistently provide care and supervision in accordance with R1’s assessed needs and level of care. Evidence indicated that required assistance and monitoring were not provided at appropriate intervals, demonstrating gaps in supervision.



Based on LPAs observations, interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D and civil penalty is being issued.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2025 and conducted by Evaluator Ardalan Gharachorloo
COMPLAINT CONTROL NUMBER: 15-AS-20250813143400

FACILITY NAME:EMERALD VALLEYFACILITY NUMBER:
019201167
ADMINISTRATOR:ESPINOZA, MARISSA KFACILITY TYPE:
740
ADDRESS:7601 AMADOR VALLEY BLVDTELEPHONE:
(925) 361-0913
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:80CENSUS: 72DATE:
02/19/2026
UNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Janelle Douglas, Executive DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is verbally abusive to a resident while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/19/2026 at 10:26 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct to deliver findings in regard to the allegations above. LPA met with Janelle Douglas, Executive Director and explained the purpose of the visit.

LPA interviewed five staff members (S1–S5), reviewed five staff files, and examined staff logs. During interviews, staff consistently described their approach to resident care as respectful and supportive.S1 stated, “We always speak calmly and respectfully to residents,” S3 reported, “If a resident is having a difficult moment, we redirect and reassure them rather than raise our voice,” and S5 explained, “Our goal is to make residents feel safe and comfortable, so we’re mindful of our tone and words at all times.”

***CONTINUE ON 9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20250813143400
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: EMERALD VALLEY
FACILITY NUMBER: 019201167
VISIT DATE: 02/19/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
***CONTINUE FROM 9099***

A review of staff records and logs did not reveal documentation or evidence indicating verbal abuse toward residents.LPA also conducted interviews with three resident (R2,R3,R4). All three residents stated that they are satisfied with the staff.


This agency has investigated the investigation above. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250813143400
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: EMERALD VALLEY
FACILITY NUMBER: 019201167
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/20/2026
Section Cited
CCR
87623(b)(2)(A)
1
2
3
4
5
6
7
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(2) Ensuring that the bag and tubing are changed by...(A)The bag may be emptied by facility staff who receive instruction from an appropriately skilled professional.
1
2
3
4
5
6
7
The licensee must ensure that trained staff are assigned and available to monitor and manage R1's catheter as required by the care plan. An attestation letter and plan of monitoring by ED to be submitted to CCL by 02/20/2026
8
9
10
11
12
13
14
Based on interviews, record review, and documentation provided by W1, the facility did not ensure that person trained to provide catheter care was available to monitor and manage R1's foley catheter in accordance with the resident's care plan which poses an immediate health and safety risk to the resident.
8
9
10
11
12
13
14
Type B
02/26/2026
Section Cited
CCR
87466
1
2
3
4
5
6
7
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any.
1
2
3
4
5
6
7
Licensee shall conduct in-service training for all staff and submit the signed training log to CCL by POC date.
8
9
10
11
12
13
14
Based on documentations provided by W1, records review and interviews, care and supervision was not in accordance with R1's assessed needs which poses a potential health and safety risk to the resident.
8
9
10
11
12
13
14
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: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5