306004520-3-14-2023-22-AS-SSAS-CQ7VX2-20230323164849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004520
Report Date: 03/14/2023
Date Signed: 03/14/2023 01:58:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
07/29/2021 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210729150626

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: 89	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Fred Paoli, Administrator		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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-Resident sustained injury while in care

INVESTIGATION FINDINGS:

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

Findings are based upon the Department investigation which included file review of medical records and interviews.

It is alleged that resident sustained injury while in care. File review revealed that R1 and R2 moved into the facility on July 06, 2021 where they shared an apartment together. R2 is R1’s POA to make any medical decisions. R1 required assistance with bathing and toileting needs. R1 was able to transfer in and out of bed on their own but with stand-by assistance from R2 or facility staff. R2 was completely mobile and did not

Continued on LIC809-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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 22-AS-20210729150626

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MERIDIAN AT LAGUNA HILLS	FACILITY NUMBER: 306004520
	VISIT DATE: 03/14/2023

NARRATIVE

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require assistance from facility staff. R1 was able to walk in short distances with the assistance of a walker or an escort. The assistance of a wheelchair was required for longer distances. R1 had minor cognitive issues such as occasional confusion. From the period of July 18, 2021 to July 25, 2021 R1 suffered four falls in the apartment. All falls were reported as slips from the bed or wheelchair and were un-witnessed by staff. R2 witness all falls and reported that R1 did not hit their head. On each occasion of falls R1 was found seated on the floor next to the bed or wheelchair and there was no visible injuries or complaint of pain.

Interviews with staff revealed that S1 became concerned about R1’s falls and discussed with R2 possibly moving R1 to Memory Care for a higher level of care and supervision. S1 also suggested R2 to hire a private caregiver to provide R1 with 24-7 care. S1 indicated that R2 did not seem receptive to any of the suggestions. On July 26, 2021 around 9:00am R2 notified staff that R2 and R1 would be out of the facility to look for a board and care facility to move to. R1 was assisted by staff to R2’s vehicle with transfer from the wheelchair into the vehicle. At the time of departure there was no indications of an injury and R2 did not indicate R1 had suffered a fall or injury. R2 returned the same day without R1 and staff questioned R2 it as indicated that R1 had suffered a fall while they were out in the community and he was taken to the hospital to be evaluated. Interview with R2 revealed that when initially asked about the fall R2 indicated that R1 did not fall while they were of to the facility on July 26, 2021. When asked again R2 said “not to my knowledge” R2 confirmed they were with R1 and witnesses the previous falls in the apartment in the facility and indicated that R1 never hit their head or suffered any injuries other that minor bruising. Interview with S2 revealed that R2 spoke to S2 on July 26, 2021, upon returning to the facility and was told by R2 that R1 had suffered a fall while they were out of the facility.

In review of medical records during R1’s visit to the hospital on July 26, 2021, R1 was diagnosed with a left subdural hematoma. During the investigation there was no evidence found to indicate R1 suffered a fall and head injury prior to leaving the facility on July 26, 2021. The evidence provided by file review, interviews and medical records shows that it is more likely that R1 suffered a fall while out of the facility under R2’s supervision.

Based on the information mentioned above, the Department is unable to ascertain if the allegation 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, this allegation is deemed Unsubstantiated.

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

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

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