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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 515002765
Report Date: 05/01/2025
Date Signed: 05/01/2025 11:04:17 AM

Unsubstantiated


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
02/24/2025 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20250224113051
FACILITY NAME:EMERALD OAKSFACILITY NUMBER:
515002765
ADMINISTRATOR:BAINS, GURPRITFACILITY TYPE:
740
ADDRESS:2290 FORREST LANETELEPHONE:
(530) 490-1401
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY:116CENSUS: DATE:
05/01/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:TIME COMPLETED:
11:13 AM
ALLEGATION(S):
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Staff did not timely respond to a resident's alerts
Staff did not provide adequate care and supervision to a resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) K. Hiratsuka conducted this visit to complete the complaint. LPA met with Assistant Administrator Ivy Garner LPA has spoken with residents, staff, reviewed documentation.

Title 22 regulations requires an alert system for residents to request assistance. The regulations do not state a specific time frame the calls for assistance have to be answered. LPA was unable to determine if the resident was able to articulate time. Staff stated there were times they were notified by a witness the resident used the call button and the resident did not. LPA interviewed a couple of residents and the response times varied. Staff stated they do frequent checks as well as respond to call lights within ten minutes. The facility is not required to have a call system log and this facility does not. LPA cannot determine whether staff responded to the resident alerts or not or in what time frame.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
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 59-AS-20250224113051
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 OAKS
FACILITY NUMBER: 515002765
VISIT DATE: 05/01/2025
NARRATIVE
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Through interviews the resident did get up on their own instead of waiting for staff assistance without using the call button to request assistance. LPA cannot determine if the resident used the call button to request assistance or not. Staff stated they do frequent checks of the residents. LPA cannot prove or disprove because each side has their own version of events.

Therefore, LPA finds the allegation to be "unsubstantiated." A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the violation occurred.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
02/24/2025 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20250224113051

FACILITY NAME:EMERALD OAKSFACILITY NUMBER:
515002765
ADMINISTRATOR:BAINS, GURPRITFACILITY TYPE:
740
ADDRESS:2290 FORREST LANETELEPHONE:
(530) 490-1401
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY:116CENSUS: DATE:
05/01/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ivy GarnerTIME COMPLETED:
11:13 AM
ALLEGATION(S):
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Staff are not properly trained on how to properly execute transfers and lifts
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) K. Hiratsuka conducted this visit to complete the complaint. LPA met with Assistant Administrator Ivy Garner LPA has spoken with residents, staff, reviewed documentation.

Title 22 Regulations do not require facilities to use hoyer lifts, gait belts, or any device to assist with transferring or lifting residents up. LPA reviewed staff training and conducted interviews. Staff have the training required by Title 22 Regulations.


Therefore, the allegation is UNFOUNDED. An outcome of unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiencies were cited at this visit. Exit interview conducted.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3