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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608787
Report Date: 11/18/2022
Date Signed: 11/18/2022 12:47:10 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2022 and conducted by Evaluator Ana Soto
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20221114132949
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: 11DATE:
11/18/2022
UNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Anita Csukardi, Executive DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff are not trained.
Staff not responding to resident's call pendant in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ana Soto conducted an initial complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Anita Csukardi, Executive Director.

The investigation consisted of following: Interviews and Record reviews. On 11/18/22, LPA Soto interviewed S#1 - S#5, R#1 - R#5, toured the kitchen, dining area, and observed the food which was provided during lunch, LPA toured room 24 & ??. LPA pull wall alarm for room #24. LPA requested and received the following documents: Resident Roster, Staff Schedule, Menu, and Staff Trainings for S#1 - S#3.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
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 11-AS-20221114132949
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MERIDIAN AT OCEAN VILLA
FACILITY NUMBER: 197608787
VISIT DATE: 11/18/2022
NARRATIVE
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Based on the LPA's investigation, the investigation revealed the following.

Allegation 1 – Staff are not trained. Interviews with staff, communicated that they very well trained. They have been working at the facility for years. The residents like their food and they are always pleased with the food. Interview with resident's communicated that the food service is good. The food taste good. All the staff is well trained, they provide good care for the residents. LPA observed the residents and staff during the lunch hour. The staff brought out the food in a timely manner. The facility was celebrating (Staff appreciation day) they provided pizza for the staff and the resident's. A staff member assisted a residents by feeding resident. The resident's joined in the celebration. LPA reviewed the menu and it had a variety of nutritional foods which they serve every day. LPA also reviewed the staff training, they have the proper training to take care of the residents needs. The interviews, observation, and records reviewed did not concur with the above allegation.

Allegation 2 - Staff not responding to resident's call pendant in a timely manner. Interviews with S#1, S#2, & S#5, communicated that the staff always responds to the pendant in a timely manner. When the resident presses the pendant, a signal goes directly to the pagers that the care givers and medication technicians carry with them at all times. Once they receive the call they respond with 5 minutes to help the resident. If the care giver or medication technician's are busy, another team member responds to the call and awaits the care givers or medication technician's to arrive. Interviews with S#3 & S#4, communicated that they only deal with the food service, the care givers deal with resident's pendants. R#1 - R#4, communicated that they have not needed to push or pull the pendant button and/or the wall alarm in their rooms, so they wouldn't know if the staff comes timely or not. The staff is great with the resident's, none of them have any complaints. R#5 communicated that staff sometimes takes a while to respond to the pendant. LPA pull the wall alarm in room 24, it took medication technician 5 minutes to respond to the call and reset the call button. The interviews conducted and observations, did not concur with the above allegation

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted with Anita Csukandi, Executive Director, and a hard copy of report was provide.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2