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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001407
Report Date: 04/30/2025
Date Signed: 04/30/2025 09:25:00 AM

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
04/23/2025 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20250423090249
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:299CENSUS: 252DATE:
04/30/2025
UNANNOUNCEDTIME BEGAN:
07:40 AM
MET WITH:Kelsey Repik and Dillon CaguladaTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Facility has foul smelling odor
Staff not addressing residents needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. Executive Director Dillon Cagulada arrived during the visit.
During the course of the visit, LPA toured the facility and interviewed residents and staff. Regarding the allegations that staff not addressing residents needs and facility has a foul smelling odor, the investigation revealed the following: Facility appears clean, safe and sanitary without any odors present. LPA toured Resident 1's (R1) room and observed it was clean and without odor. Six out of six residents interviewed stated facility is clean and odor free. R1 resides in independent living in the community and was receiving no assistance with activities of daily living and does not have a care plan in place. Resident was provided an eviction notice on 04/11/2025 for violation of admission agreement and violation of resident handbook for aggressive behaviors. Per facility documentation, R1 was put on a 5150 hold on 02/19/2025 resulting in a diagnosis of schizo-affective disorder. CONTINUED ON LIC 9099C DATED 04/30/2025
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025
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 2
Control Number 22-AS-20250423090249
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: 04/30/2025
NARRATIVE
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Based on interviews conducted and records reviewed, the above allegations are deemed UNFOUNDED meaning that the allegations were false, could not have happened and/or is without a reasonable basis.


Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2