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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001407
Report Date: 07/01/2025
Date Signed: 07/01/2025 04:43:00 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
06/25/2025 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250625105327
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: 153DATE:
07/01/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Dillon CaguladaTIME COMPLETED:
03:44 PM
ALLEGATION(S):
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Facility kitchen equipment is broken.
Facility staff does not keep facility free from pests.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit upon entering the facility. At the beginning of the visit, LPA Haley was led on a brief tour of the facility by Executive Director Dillon Cagulada.

Regarding the complaint allegation: Facility kitchen equipment is broken.
During the investigation, 6 of 10 individuals interviewed confirmed there are several pieces of equipment in the kitchen that are broken or are not properly working. During interviews, it was discovered the following items are broken or not properly working: a commercial toaster, multiple freezers, the steamer, two stove ovens, a flat top stove, griddle, soup warmer, plate warmer, and a food warmer. During the visit, areas of the kitchen were closely observed and items that needed repair or replacement were photographed.

Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
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-20250625105327
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: EMERALD COURT
FACILITY NUMBER: 306001407
VISIT DATE: 07/01/2025
NARRATIVE
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According to Staff 1 (S1), after discovering kitchen equipment was not working at all or not properly working, a request was made to approve capital expenses. S1 also explained that another member of the management team has been trying to repair some of the equipment in the kitchen that’s broken or not properly working by having parts replaced/repaired.

Regarding the complaint allegation: Facility staff does not keep facility free from pests.

During the investigation, 4 of 10 individuals confirmed they have seen a bug in the facility. While walking around the kitchen to make observations, bugs were observed and photographed. A brown color bug was running across the commercial dishwasher, a couple black bug were observed crawling on the floor behind the kitchen area, and flies were observed in one of the dining rooms on some of the utensils and on some fruit that was nearby. Photos were taken and a video of some of the flies was captured.

Based on the evidence gathered through interviews, and observations the preponderance of evidence standard has been met, therefore, the above allegations are SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250625105327
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: EMERALD COURT
FACILITY NUMBER: 306001407
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2025
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
This requirement is not being met as evidenced by:

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Executive Director states, receipts, and invoices, will be provided for all kitchen equipment that needs repair or replacement by Tuesday, July 8, 2025. Executive Director will provide dates of delivery and installation of the new equipment. For equipment that need repairs, Executive Director will provide receipts for all repairs made for all kitchen equipment including: both ovens, steamer, flat top, griddle, commercial toaster, plate warmer, food warmer, soup warmer, and freezers.
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Equipment in the kitchen that is not working or not properly working were confirmed by multiple individuals and photos were taken. Further, a request was made to approve expenses that will be used to purchase new equipment or repair the existing equipment.
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Type B
07/08/2025
Section Cited
CCR
87555(b)(27)
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87555 General Food Service Requirements
(b) The following food service requirements shall apply:
(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.
This requirement was not met as evidenced by:
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Executive Director states the regulation section will be reviewed. After reviewing the regulation section a statement of acknowledgement and understanding will be provide that includes a plan that will be implemented to prevent the presence of bugs and flies in the future.
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During the visit, LPA Haley observed bugs on the ground in an area behind the kitchen, a bug crawling across the commercial dishwasher, and flies flying over some fruit and utensils in one of the dining rooms. Photos were taken and a video was captured.
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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: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC9099 (FAS) - (06/04)
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