306004520-8-26-2024-22-AS-SSAS-D9B32F-20240920175151

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004520
Report Date: 08/26/2024
Date Signed: 08/26/2024 03:09:47 PM

Unfounded

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
08/13/2024 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240813093648

FACILITY NAME:	MERIDIAN AT LAGUNA HILLS		FACILITY NUMBER:	306004520
ADMINISTRATOR:	MARIA ROSSI		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: 72	DATE:	08/26/2024
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Cheryle Clark, Business Office Manager		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Wrongful Eviction.

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 and granted entry by receptionist. LPA spoke with Cheryle Clark, Business Office Manager and explained the purpose of the visit.

Findings are based upon this investigation which included file review, and interviews conducted. It is alleged that facility gave resident (R1) a wrongful eviction. Upon review of records reflect that on July 17, 2024, the facility served a 30 day eviction due to change in condition and facility no longer able to provide care for resident. Facility sent a copy of the eviction to DSS, Ombudsman and to R1’s responsible party. Records review revealed upon admissions resident was level 2 care. Facility re-assed R1 on October 11, 2023, that resulted in level 2 care and December 15, 2023, April 11, 2024, and May 24, 2024, resulting

Continued on LIC9099-C

Unfounded

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: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

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-20240813093648

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: 08/26/2024

NARRATIVE

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in level 3 care. R1 appraisal/needs and services plan reflects the following was added based on the change of condition on May 24, 2024, for confusion is total assist, and wandering behavior was effective April 11, 2024, for mechanical and human help: supervision. Narrative charting reflects that from May 26, 2022, to August 7, 2024, resident has been displaying wondering, confusion, and disorientation behavior. Charting for April 15, 2022, reflects that R1 was moved from independent living to assisted living. Interview with witness W1 revealed that they live in building B for independent living and since R1 has been wondering and confused they have been assisting R1 by keeping R1 company for most of the day. W1 stated that if they are not with R1 they get lost in the community, R1 never leaves the community, but does wonder and is not able to find their apartment. Interview with 2 of 2 staff revealed that R1 requires more care than staff could provide, and it is taking away care time for the rest of the residents. Staff tries to accommodate as much as possible. Administrator due to condition re-assessed R1 and determined needs and care for R1 could not be fulfilled by staff.

We have found the complaint allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with 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: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

LIC9099 (FAS) - (06/04)

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