197609522-3-10-2022-31-AS-TCAS-CCDPR9-20220310103222

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609522
Report Date: 03/10/2022
Date Signed: 03/10/2022 10:34:15 AM

Document Has Been Signed on 03/10/2022 10:34 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	MERIDIAN ELDERLY ASSISTED LIVING		FACILITY NUMBER:	197609522
ADMINISTRATOR:	TAN, C SAMUEL		FACILITY TYPE:	740
ADDRESS:	11343 SATICOY STREET		TELEPHONE:	(818) 308-7553
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY:	6	CENSUS: 6	DATE:	03/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rima Abelian		TIME COMPLETED:	10:40 AM

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced infection control inspection/visit. Upon arriving, LPA was greeted outside by Co-Administrator Rima Abelian, who allowed LPA to enter the facility. According to Rima, there have not been any active or past COVID cases at the facility, and has been COVID free since the beginning of the pandemic. There are currently (5) residents vaccinated, and (1) who refused. There are (3) staff vaccinated; no-one from the facility has received the booster shot. The current census is (6). LPA and Co-Administrator entered through the front door of the facility, and temperature was taken, and LPA observed the visitors sign in sheet and cleaning table, with hand sanitizer. LPA observed both staff to have full mask covering. COVID-19, CDC, Department of Public Health, and Licensing postings on the walls throughout the facility.

The infection control inspection began with the Co-Administrator, who escorted LPA throughout the facility. There are (3) bathrooms, with hand-washing signs, and there are (6) bedrooms; with (1) room for staff and (1) room for Administrators. All bedrooms were properly furnished; with a COVID-19 posting on each resident's bedroom door. The common areas were observed to be clean, including bathrooms, with soap and towels. LPA conducted a mitigation plan and facility operation review with the Co-Administrator. LPA was informed, former Administrator Samuel Tan passed away in December 2020, and there is a new Administrator Maro Kariban operating the facility. LPA requested all documents and information to be emailed, with certificate and ID. The COVID review was the following:

The Co-Administrator reported to LPA, the facility has documentation of all vaccination records and other pertinent information pertaining to COVID-19, in staff and resident files. All new employee hires and new resident admits, will be properly screened, and provided a negative COVID test before entering the facility. New hires are required to be vaccinated.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MERIDIAN ELDERLY ASSISTED LIVING	FACILITY NUMBER: 197609522
	VISIT DATE: 03/10/2022

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Co- Administrator reported the Administrator receives and reviews all the departmental emails and continues to provide and conduct training to staff in relation to COVID-19. There is currently a paid sick leave policy in place. The facility does not have staffing issues, due to having a back-up staff available when needed. There is (1) designated room for potential positive COVID residents; LPA observed and identified the room which was properly labeled with a posting.

PPE supplies were inspected, and facility has an abundance of PPE supplies available. Chemicals, cleaning supplies, paper products were observed and locked and secured. Co-Administrator informed LPA that they continue to implement the best practices for their facility, which has kept them COVID-19 free since the beginning of the pandemic. The facility is aware to report any changes with residents and staff to Licensing and there LPA, pertaining to positive COVID-19 cases. New Administrator information, must be emailed to LPA to make the correct changes. Facility contact information was also obtained for both Administrators.

Exit interview was conducted, and copy of report will be emailed to Administrator.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC809 (FAS) - (06/04)

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