306004520-4-2-2024-22-AS-AJLO-D4FUQ3-20240418154627

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004520
Report Date: 04/02/2024
Date Signed: 04/02/2024 02:35:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
03/27/2024 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240327150008

FACILITY NAME:	MERIDIAN AT LAGUNA HILLS		FACILITY NUMBER:	306004520
ADMINISTRATOR:	TIERRE THORNTON		FACILITY TYPE:	740
ADDRESS:	24552 PASEO DE VALENCIA BLDG A		TELEPHONE:	(949) 581-6111
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	150	CENSUS: 77	DATE:	04/02/2024
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Karen Enciso, Continuous Improvement Specialist		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility failed to treat and resolve a mold condition in the living community that has affected residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA arrived at the facility was greeted by receptionist and granted entry. LPA met with Karen Enciso, Continuous Improvement Specialist and explained the nature of today’s visit.

Findings are based upon this investigation which included a tour of the physical plant of the facility, interviews, and copy of microbial air sampling report. It is alleged that facility failed to treat and resolve a mold condition in the living community that has affected residents. Based on information received resident rooms affected is in building B and building A, 6th floor. Incident on building A 6th floor was addressed back in January 2024 and resolved. Interviews conducted with 3 of 3 staff verified that they had received

Continued on LIC9099-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: 04/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024

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-20240327150008

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MERIDIAN AT LAGUNA HILLS	FACILITY NUMBER: 306004520
	VISIT DATE: 04/02/2024

NARRATIVE

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a complaint from a resident that resides in building B regarding mold and that is being addressed. Facility staff indicated that the only other complaint to check was for resident services directors’ office located in building A 2nd floor. However, documentation copies received for the testing done by a testing vendor indicated that testing was done to that office and the air sampling results show the office is safe for occupancy. Copies of documentation obtained of the microbial air sampling report page 1 indicates: Lead Tech Environmental (LTE) performed air sampling at the RSD Office located at 24552 Paseo Valencia, Laguna Hills, CA (“Office”). LTE performed the evaluation on March 20, 2024. As part of this evaluation, he took air samples for determination of non-viable fungi. The scope of sampling was limited to the collection of one interior sample and one exterior, control sample. LTE did not observe visible signs of mold. Based on the results of the air sampling, the microbial evaluation, and visual observations, the Office was safe for occupancy. The exterior/control sample contained a higher mold spore count than the interior air sample. Furthermore page 4 indicates: The air sample results show the Office is safe for occupancy. At the time of this writing, no Threshold Limit Values (TLVs) or Permissible Exposure Levels (PELs) for mold have been established. It should be noted that surfaces of construction and finishing materials, as well as indoor air, are not sterile, and that no structure is ever completely free of microbial contaminants. Under normal circumstances, under current industry guidelines, we would expect the levels of fungi in the indoor environment to be qualitatively and quantitatively lower or at most similar to the air outside of the residence. LPA conducted a tour of building A floors 1-5 and inspected resident’s bedroom and common areas and did not observe visibly any sign of mold. Based on the information on file for the facility CCLD licensure covers building A, floors 1-5. Building B and Building A floors 6-7 are independent living and is not covered under CCLS licensure for this facility.

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 the facility representative 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: 04/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024

LIC9099 (FAS) - (06/04)

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