306004520-11-8-2022-22-AS-MSTC-CLP7QW-20221130205232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004520
Report Date: 07/12/2022
Date Signed: 11/08/2022 11:42:34 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2021 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210804162018

FACILITY NAME:	MERIDIAN AT LAGUNA HILLS		FACILITY NUMBER:	306004520
ADMINISTRATOR:	MALLIKA PURI		FACILITY TYPE:	740
ADDRESS:	24552 PASEO DE VALENCIA		TELEPHONE:	(949) 581-6111
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	150	CENSUS: 70	DATE:	07/12/2022
		UNANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:	Fred Paoli		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Staff did not assist resident with glucose testing.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA arrive at facility was greeted by receptionist and granted entry. LPA spoke with Fred Paoli, Administrator and explained the purpose of the visit.

Findings are based upon this investigation which included interviews conducted, tour of physical plant of facility and review of records.

It is alleged staff did not assist resident with glucose testing. Records review revealed that R1’s physician’s report page 4 number 16 medication management R1 is able to administer own prescription medication, able to administer own injections and able to perform own glucose testing. Per Title 22 Regulation 87628(a) diabetes - The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

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 22-AS-20210804162018

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MERIDIAN AT LAGUNA HILLS	FACILITY NUMBER: 306004520
	VISIT DATE: 07/12/2022

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
26
27
28
29
30
31
32

his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. Per record review revealed R1 was not on insulin at the time of incident. Records indicate prescription for insulin was from November 11, 2021. Per interview with staff (S1) revealed that facility staff do not assist with glucose testing because there is no medical staff at facility. Staff do not administer test however facility does house the glucose meters in the medication cart and a resident is delivered their medication the med tech hands the glucose meter to residents so they can do their testing. Staff do provide guidance if needed but do not perform the actual glucose test for them. Staff indicated that R1 was able to perform glucose testing at all times and has never needed assistance with performing test. In the case that assistance was needed staff would guide R1’s hands and also collect and store the meter when completed.

Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, these allegations are deemed Unsubstantiated.

An exit interview was conducted with the Administrator and a copy of this LIC9099 report was left at facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2