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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 04:01:04 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
09/25/2025 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20250925141550
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:
01:00 PM
MET WITH:Natalia TuleninovaTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Staff do not provide adequate supervision resulting in residents wandering away from facility.
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, Staff do not provide adequate supervision resulting in residents wandering away from facility. Based on file review conducted of Sacramento County Sheriff's Office reports, it revealed that resident (R1) had eloped from the facility on July 20, 2025. Local law enforcement was contacted at approximately 12:04 PM regarding R1 being at caller (C1)'s door, it was reported that staff wearing a scrub appeared at the house at approximately 12:16 PM to retrieve R1 back to the facility. On September 2, 2025 at approximately 12:26 PM there was another call to local law enforcement by caller (C2) regarding R1 being lost at their door. C2 was advised to keep R1 at the location until law enforcement arrives at the scene. It was reported that at approximately 12:38 PM, R1 returned to the facility with a care staff.

Please continue 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 2
Control Number 59-AS-20250925141550
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 witness (W1), it revealed that R1 has eloped from the facility in multiple occasion without staff present but W1 knows R1 belongs to the facility and would assist with walking R1 back to the facility. W1 stated there was a time that R1 wandered to their neighbor's house to ask for a cigarette, after R1 finished the cigarette, R1 allowed the individual to return R1 back to the facility. Interview conducted with witness (W2) revealed that W2 has a ring camera at their front door. W2 has footage of R1 wandering to the door steps. There was an occasion where R1 was not supervised and another occasion where R1 was followed by a staff member. W2 informed LPA local law enforcement has been contacted in a couple of occasion by various bystanders.

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, but no deficiency will be cited as LPA substantiated the similar allegation for Complaint 59-AS-20250821090941 on November 19, 2025.

Exit interview conducted, copy of 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 2