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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920258
Report Date: 11/19/2025
Date Signed: 11/19/2025 03:59:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2025 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20250821090941
FACILITY NAME:EMERALD SENIOR CAREFACILITY NUMBER:
345920258
ADMINISTRATOR:TULENINOVA, NATALIAFACILITY TYPE:
740
ADDRESS:4824 ALEXON WAYTELEPHONE:
(916) 257-4525
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Natalia TuleninovaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not respond to resident's call light in a timely manner
INVESTIGATION FINDINGS:
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On November 19, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to deliver the finding of the allegation cited above. LPA met with Administrator and explained the purpose of the visit.

During the course of the investigation, the department conducted extensive interviews and file reviews. For the allegation of, Staff did not respond to resident's call light in a timely manner, interview conducted with resident (R1) revealed that R1 has requested medication assistance utilizing the call light the morning of August 21, 2025 but received no assistance. R1 stated R1 had to go to the common area looking for staff but they were unavailable. File review of R1's LIC 602 revealed R1 is unable to store and/or administer own medications. Interview conducted with R2 revealed that it takes at least 30 minutes for staff to come to the room to assist with incontinence care. R2 stated usually staff are occupied with other residents in care as multiple residents are incontinence as well. R2 reported R2 is unable to transfer out of bed and does need staff assistance with changing. R2 emphasized that staff are great but "everyone needs help, not just me". File review of R2's LIC 602 revealed no indication of dementia diagnosis, and and is unable to care own toileting needs.

Please continue narrative on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
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 3
Control Number 59-AS-20250821090941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: EMERALD SENIOR CARE
FACILITY NUMBER: 345920258
VISIT DATE: 11/19/2025
NARRATIVE
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LIC 9099-C

Interview conducted with R3 revealed that facility is improving on responding to calls but during the day of LPA's visit, R3 called for assistance but staff was busy changing other residents in care so R3 had to wait for incontinence care. It was reported R3's last changing was the night prior at approximately 9:00 PM and did not receive assistance from staff for a new depend until approximately 3:00 PM. R3 reported that there are usually two caregivers working at the facility, not necessarily are staff ignoring residents' calls, but "they are doing the best they can, we all need help." R3 reported R3 has a prohibited health condition in the buttock area which is critical for incontinence care to be conducted in a timely manner but staff are sometimes not available. File review of R3's LIC 602 revealed no indication of dementia diagnosis,and is unable to care own toileting needs. Interview conducted with R4 revealed that R4 does not recall if staff responds to call lights in a timely manner. Interview conducted with R5 revealed that R5 is fine at the facility and "never needs help". Interview conducted with R6 revealed R6 does not have any information to share with the department at this time. Interview conducted with S1 revealed that residents are to use the call lights for whatever they need. If staff are busy with other residents in care, then staff does inform residents to wait until staff are available. Interview conducted with S2 revealed staff does not neglect residents in care, but there are multiple residents that requires incontinence care in bed and are bed bound so it takes a little longer to complete the task before moving onto the next individual.

Based on the information obtained, the allegation is SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following allegation cited above is substantiated, please see LIC9099-D.

Exit interview conducted and a copy of the report and appeal rights was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
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 3
Control Number 59-AS-20250821090941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: EMERALD SENIOR CARE
FACILITY NUMBER: 345920258
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...

This requirement is not met as evidenced by:
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Licensee will conduct an in-service on how to utilize the call lights appropriately.

Additionally, Licensee will conduct an audit on resident's care needs to determine if additional staffing is needed. Notification of completion is to be submitted to LPA by due date.
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Based on interviews conducted, Licensee did not comply as staff are unable to assist residents' needs in a timely manner which poses a potential risk for residents in care.
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Plan of Correction is due December 1, 2025
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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: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

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

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3