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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920258
Report Date: 12/01/2025
Date Signed: 12/01/2025 02:13:24 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
11/21/2025 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20251121125610
FACILITY NAME:EMERALD SENIOR CAREFACILITY NUMBER:
345920258
ADMINISTRATOR:ALEKSANDR PROKHOROVFACILITY TYPE:
740
ADDRESS:4824 ALEXON WAYTELEPHONE:
(916) 257-4525
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: DATE:
12/01/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:ALEKSANDR PROKHOROVTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Staff did not treat residents with dignity and respect.
Staff did not ensure that residents are fed in a timely manner.
INVESTIGATION FINDINGS:
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On December 1, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to open the complaint the Department received to investigate the allegations cited above. LPA met with Administrator and explained the purpose of the visit.

The course of investigation, LPA conducted extensive interviews.

The findings are as follow, please continue to LIC 9099-C.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
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 4
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
11/21/2025 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20251121125610

FACILITY NAME:EMERALD SENIOR CAREFACILITY NUMBER:
345920258
ADMINISTRATOR:ALEKSANDR PROKHOROVFACILITY TYPE:
740
ADDRESS:4824 ALEXON WAYTELEPHONE:
(916) 257-4525
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
12/01/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:ALEKSANDR PROKHOROVTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Staff do not ensure that the residents' bathrooms are cleaned.
INVESTIGATION FINDINGS:
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On December 1, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to investigate the allegation cited above. LPA met wiht Administrator and explained the purpose of the visit.

During the investigation of Staff do not ensure that the residents' bathrooms are cleaned, LPA and Administrator conducted an inspection of the bathrooms in the facility. Based on observation, LPA observed bathrooms to be clean and sanitary, free of any odor. Additionally, based on interview conducted with R1 revealed that R1 does not have any concerns regarding the bathroom not being clean.

Based on information above, the department concluded that the allegation is unfounded. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview and copy of report provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20251121125610
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: 12/01/2025
NARRATIVE
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LIC 9099-C

For the allegation of, Staff did not treat residents with dignity and respect, it was revealed that S1 was terminated from the facility due to insubordination and incompetence. Interview conducted with R1 revealed that S1 was “ok” but could be better. R1 emphasized that S1 did not know how to speak gentle to residents in care. Interview conducted with R2 revealed that S1 was a “moody” person and would yell at residents if S1 is feeling overwhelmed. R2 emphasized that S1 would call R2 a liar when R2 complains about not receiving PRN medications. Interview conducted with R3 revealed that S1 was a “terrible, mean lady”. R3 stated R3 has witnessed S1 making another resident pee in their briefs rather than taking the resident to the bathroom, even when the other resident was adamant they did not want to pee in the briefs. R3 stated S1 would talk down to residents in care in a sarcastic way. Based on information obtained, allegation is substantiated.

Allegation of, Staff did not ensure that residents are fed in a timely manner, interview conducted with Administrator revealed that breakfast is typically served at 8:30 AM, lunch is at 12 PM and dinner is at 5 PM. Interviews conducted with residents in care revealed that when S1 was working at the facility, breakfast and lunch would be served late. Interview with R1 revealed that S1 would often serve breakfast whenever S1 wants to at approximately 10 AM. R1 does not recall S1 making breakfast on time. R1 stated lunch has often been served at 2 PM. Interview conducted with R2 revealed that S1 often likes to be on the phone and does not get breakfast ready until 9:30 AM, close to 10 AM. R2 does not recalled breakfast being ready on time at 8:30 AM. R2 stated S1 does serve dinner late periodically but often on time. Interview conducted with R3 revealed that S1 does not have a routine and often serves meals late. R3 stated there has been times when R3 goes to the dining table in the morning but there is no breakfast being made yet.

Based on the information obtained, the allegations are 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: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20251121125610
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: 12/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2025
Section Cited
CCR
97468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
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Licensee is to conduct an in-service training for all staff on LIC 500 of CCR 87486.1 Personal Rights of Residents in All Facilities

Notification of completion is to be submitted to LPA by Friday December 12, 2025.
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Based on interviews conducted, Licensee did not comply as S1 did not treat residents in care with dignity, which poses an potential risk to residents in care.
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Type B
12/12/2025
Section Cited
CCR
87555(b)(1)
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87555 General Food Service Requirements (b) The following food service requirements shall apply: (1) Where all food is provided by the facility arrangements shall be made so that each resident has available at least three meals per day...Not more than fifteen (15) hours shall elapse between the third and first meal. This requirement is not met as evidenced by:
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Licensee will adjust meal time to be compliance to Title 22 and post the notification at the facility and provide a copy to LPA by due date of Friday December 12, 2025.
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Based on interviews conducted, Licensee did not comply as S1 would serve residents in care dinner at approximately 5 PM but breakfast the following morning at approximately 9 to 10 AM exceeding 15 hours, which poses a potential risk for residents in care.
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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: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4