197608788-3-6-2023-11-AS-DESA-CPNR9W-20230306115010

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608788
Report Date: 03/06/2023
Date Signed: 03/06/2023 11:50:39 AM

Document Has Been Signed on 03/06/2023 11:50 AM - 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 BELLA MAR		FACILITY NUMBER:	197608788
ADMINISTRATOR:	SHAWN C. MOONEY		FACILITY TYPE:	740
ADDRESS:	825 OCEAN AVE		TELEPHONE:	(310) 393-5258
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90403
CAPACITY:	36	CENSUS: 0	DATE:	03/06/2023
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	08:04 AM
MET WITH:	Mrs. Christina Harris, LVN.		TIME COMPLETED:	12:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Case Management visit A Licensing Program Analyst (LPA), David Espana, conducted an announced visit at Meridian at Bella Mar 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 Bella Mar 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 Bella Mar 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 § Mrs. Christina Harris provided facility license on 3/06/2023 at 08:49 hours. “Cont’d” on 809c

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (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 BELLA MAR	FACILITY NUMBER: 197608788
	VISIT DATE: 03/06/2023

NARRATIVE

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§The Regional Director of Clinical Operation California, Mrs. Christina Harris, LVN. will be sent by USPS mail, specifically: LIC809 LIC809-C with signatures and a date, 16256 Lomacitas LN Whittier, CA 90603.
§ The facility has a kitchen, foyer, dining rooms, and different leisure areas and terraces.
§ 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 announced 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 Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (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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