197609522-9-23-2020-31-AS-CHAS-BUFRJ9-20201016130335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609522
Report Date: 09/23/2020
Date Signed: 09/23/2020 01:49:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/13/2020 and conducted by Evaluator Wendell Smith

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20200313144556

FACILITY NAME:	MERIDIAN ELDERLY ASSISTED LIVING		FACILITY NUMBER:	197609522
ADMINISTRATOR:	TAN, C SAMUEL		FACILITY TYPE:	740
ADDRESS:	11343 SATICOY STREET		TELEPHONE:	(818) 822-0911
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY:	6	CENSUS: 6	DATE:	09/23/2020
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Samuel Tan		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff did not provide food of the quality necessary to meet the needs of residents.
Staff adminstered medication to resident without the resident's knowledge and consent.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted virtually through face-time with Samuel Tan, the facility administrator.
Staff did not provide food of the quality necessary to meet the needs of residents.
Regarding this allegation LPA previously conducted a telephonic visit on 3/23/2020 where LPA interviewed the administrator regarding this allegation. LPA also previously spoke to the case carrying LPA who conducted a required annual visit on 2/26/2020 which was less than a month before this complaint was filed. During today's visit LPA was able to check the food supply and verified that the facility had a sufficient amount of perishable and non perishable food. LPA also conducted interviews with one of the six residents. LPA was not able to interview any more residents due to the medical diagnosis of the remaining residents. Based on the information obtained through observation and interviews this allegation is deemed Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20200313144556

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MERIDIAN ELDERLY ASSISTED LIVING	FACILITY NUMBER: 197609522
	VISIT DATE: 09/23/2020

NARRATIVE

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There was not enough information to state that facility did not have a sufficient quality of food. During the required annual visit facility was not found to not have enough quality food.

Staff administered medication to resident without the resident's knowledge and consent.
It is alleged that facility staff sedated a resident who was described as a black man with no legs. Regarding this allegation LPA conducted interviews with facility staff. LPA also spoke with the case carrying LPA who visited the facility less than a month prior to this complaint being filed. Information from interviews conducted reveal that there was no resident who fit that description in the past two years. Based on the information obtained this allegation is deemed Unsubstantiated at this time. Exit Interview conducted. Copy of report emailed.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020

LIC9099 (FAS) - (06/04)

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