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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001407
Report Date: 11/19/2025
Date Signed: 11/19/2025 12:15:47 PM

Unsubstantiated


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
01/18/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240118165523
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: 253DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Kelsey Repik Chavez-Hospitality Services DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff interfered with resident's visits
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on January 18, 2024. LPA was greeted and granted entry into the facility and met with Hospitality Services Director Kelsey Repik Chavez. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that staff interfered with resident's visits. Regarding the allegation the following was revealed: During the course of the interviews with individuals seven of nine individuals interviewed denied the allegation. During the course of the investigation LPA reviewed documents including the Emerald Court Admission Agreement dated October 29, 2021, for Resident 1 (R1). Per Admission Agreement under Guest Visits and Communication it states your guests are welcome to visit, provide they respect the rights of other residents and staff and abide by our visitor and guest policies. During the course of the interviews with witnesses, Witness 1 (W1) reported that facility denied him to visit his mother in her bedroom and stated that when visiting her mother that they would meet in the common area or dining room.
CONTINUED ON LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
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 4
Control Number 22-AS-20240118165523
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: 11/19/2025
NARRATIVE
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During the course of the interviews with residents, R2 reported that staff have never interfere when he has visitors. R3 stated that her family visits often and reported that she has never had issues with visitations. Per R4, staff do not interfere with visits and stated that he has not had visitations denied. R5 stated that staff do not interfere with visitations. Per R6, visitors have never been denied entrance to see her and reported that staff do not interfere with visitations. During the course of the interviews with staff, Staff 2 (S2) reported that staff did no interfere with the resident visits.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.

LPA conducted an exit interview with facility representative, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
01/18/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240118165523

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: 253DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Kelsey Repik Chavez-Hospitality Services DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide a copy of resident's Admission Agreement to her authorized person
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on January 18, 2024. LPA was greeted and granted entry into the facility and met with Hospitality Services Director Kelsey Repik Chavez. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that staff did not provide a copy of resident's Admission Agreement to her authorized person, the following was revealed: During the course of the investigation LPA reviewed the Emerald Court Admission Agreement dated October 29, 2021 for R1. Per Resident Admission Agreement, R1 is self responsible and R1 signed their Resident Admission Agreement. During the course of the interviews with residents, Resident 2 (R2) reported that he received a copy of his Admission Agreement and stated that he is self responsible. Per R3, the facility provided her Power of Attorney (POA) with a copy of her Admission Agreement. R4 stated that the facility provided her POA with a copy of his Admission Agreement. Per R5, he is sure the facility would provide him with a copy of his Admission Agreement.
CONTINUED ON LIC9099-C...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
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 4
Control Number 22-AS-20240118165523
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: 11/19/2025
NARRATIVE
1
2
3
4
5
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7
8
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32
R6 stated that the facility provided her daughter with a copy of her Admission Agreement. During the course of the interviews with staff, S1 reported that R1's son was notified that he was not the Responsible Party (RP) for R1; therefore, he could not get a copy of the Admission Agreement. S2 stated that R1's son was not provided with a copy of R1's Admission Agreement because R1 is self responsible.

Therefore, the allegation is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

LPA Ramirez conducted an exit interview with facility representative and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4