306004520-2-27-2025-22-AS-AJLO-DERSV4-20250314141206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004520
Report Date: 02/27/2025
Date Signed: 02/27/2025 11:06:31 AM

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
12/05/2022 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221205110013

FACILITY NAME:	MERIDIAN AT LAGUNA HILLS		FACILITY NUMBER:	306004520
ADMINISTRATOR:	FREDERICK M PAOLI		FACILITY TYPE:	740
ADDRESS:	24552 PASEO DE VALENCIA BLDG A		TELEPHONE:	(949) 581-6111
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	0	CENSUS: 0	DATE:	02/27/2025
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Eric Jensen Executive Director		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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-Facility staff not keeping resident’s room free from bugs.
-Facility pipe(s) is in disrepair.

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 allegations. LPA arrive at facility was greeted and granted entry by receptionist. LPA spoke with Eric Jensen, Executive Director and explained the purpose of the visit.

Findings are based upon this investigation which included facility file review (work orders, pest control logs, pest control contract), tour of the physical plant of the facility and interviews conducted.

It is alleged that facility staff not keeping resident’s room free from bugs. LPA on December 08, 2022, toured the facility including resident bedrooms, common areas and outside parameters and found it to be clean and did not observe any pest or evidence of pest present. LPA met and interviewed the facility

Continued on LIC9099

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: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

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-20221205110013

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: 02/27/2025

NARRATIVE

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Executive Director regarding the allegations and stated that facility has had continuous pest control service from an outside vendor. Executive Director stated that resident (R1) called the front desk to complain about bugs in their room and services were scheduled to which pest company inspected facility and R1’s bedroom on 12/06/2022 with no indications of pest found. LPA Martinez reviewed pest control contract from Orkin Commercial Services entered into contract on June 2, 2021 and is current, which indicated a detailed plan and schedule of pest control services to include outdoor, indoor, maintain rodent devices, lobby, inspect and treat monthly; break room, storage room, rest rooms, offices on request, kitchen, treat up to three residents room on request, treat exterior, bait stations and residents room on a day service. The entire facility inside and out has been treated continuously from the start of the contract of June 2, 2021, and at this time facility is pest free.

It is alleged that pipes are in disrepair. In review of work orders the following was observed that R1 submitted a request on December 4, 2022, for black stuff coming out from bathtub drain. Order was placed as urgent same day service and order reflects that order was completed on the same day of request. LPA toured R1’s bedroom on December 08, 2022, and inspected the bathroom in R1’s apartment allowing water flow from bathtub and sink for 20 minutes, no black residue was observed in the flow. Executive Director and Maintenance Director were present and informed LPA that R1 submitted complaint it was looked at and resolved on the same day of request. Since request was resolved there has been no other complaints from R1. Interview with R1 revealed that they submitted the request, and the same day issue was resolved, R1 stated they have not seen any further residue coming form pipes or water flow.

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 Executive Director and a copy of this LIC9099 report was left at the facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

LIC9099 (FAS) - (06/04)

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