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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608787
Report Date: 03/06/2023
Date Signed: 03/06/2023 12:08:56 PM


Document Has Been Signed on 03/06/2023 12:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:MERIDIAN AT OCEAN VILLAFACILITY NUMBER:
197608787
ADMINISTRATOR:SHAWN C MOONEYFACILITY TYPE:
740
ADDRESS:413 OCEAN AVETELEPHONE:
(310) 393-0242
CITY:SANTA MONICASTATE: CAZIP CODE:
90402
CAPACITY:36CENSUS: 0DATE:
03/06/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mrs. Christina Harris, LVN. TIME COMPLETED:
12:01 PM
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Case Management Visit
A Licensing Program Analyst (LPA), David Espana, conducted an announced visit at Meridian At Ocean Villa today 3/6/2023.

Documentation and Description of Facility’s Past COVID-19 Cases and Ongoing Efforts
The objective of today's announced, case management inspection was to focus on (a) Meridian At Ocean Villa closure.

Licensing Program Analyst Espana conducted a (a) risk assessment upon arriving at the front desk. According to the review, the facility has (d) 0 active COVID-19 cases. LPA Espana has (b) verified that the COVID-19 mitigation plan report for the facility has been approved. The (c) Regional Director of Clinical Operation California, Mrs. Christina Harris, LVN., met with LPA Espana.

Target Population
Throughout the visit, LPA Espana observed the facility's Meridian At Ocean Villa closure measures: 1) LPA Espana noticed a cleaning station at the facility's entryway; 2) There are now o residents at the facility; 3) The facility does not handle any resident funds; and 4) LPA Espana inspected the physical facility.

Key Facility Description - Function, # of Units, Title 22 Regulation Compliance
§ No. of total residents (clients) as of this visit: 0
§ No. of total staff as of this visit: 0
“Cont’d” on 809c
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MERIDIAN AT OCEAN VILLA
FACILITY NUMBER: 197608787
VISIT DATE: 03/06/2023
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§Mrs. Christina Harris provided facility license on 3/06/2023 at 10:02 hours.
§ The Regional Director of Clinical Operation California, Mrs. Christina Harris, LVN. will be sent to Mrs. Harris by USPS mail (report will be mail).
§ The facility has a kitchen, foyer, dining rooms, and different leisure areas and terraces.
§ Each resident's bedroom included basic furniture, table lamps, sheets, and closet/drawer space.
§ Resident toilets were examined.
§ The toilets, faucets, wheelchair access, and shower were clean.
§ The shared areas were immaculate and risk-free, and the entrances were unblocked.
§ The exit doors in the apartment are fitted with auditory alarms.
§ The designated visiting area of the facility is located on the resident's patio, in addition to the resident's bedroom.
§ All workers, residents, and visitors maintain a 6-foot distance and wear a face covering.
§ The facility followed sitewide posting standards.
§ The kitchen was examined.
§ The smoke alarms and fire extinguishers were operational and fully charged. .
§ The outside grounds were inspected, and the facility did not contain a swimming pool.
§ The facility's walkways were devoid of risks.
§ No security bars or guns are present on the grounds.
§ The facility's staff and facility grounds have been visited unannounced on a weekly or biweekly basis due to closure and for formative evaluation purposes.

No deficiencies were cited during today's visit.

The exit interview report was delivered to Mrs. Christina Harris, LVN., with signatures and a date, who is the facility's Regional Director of Clinical Operation California.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
LIC809 (FAS) - (06/04)
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