306004520-2-27-2025-22-AS-AJLO-DERTFJ-20250314144136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004520
Report Date: 02/27/2025
Date Signed: 02/27/2025 11:07:55 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
01/13/2023 and conducted by Evaluator Ruth Martinez

COMPLAINT CONTROL NUMBER: 22-AS-20230113141920

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:	08:40 AM
MET WITH:	Eric Jensen, Executive Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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* Staff failed to administer resident's medication as prescribed
* Due to language barrier staff can't communicate with residents
* Insufficient staff to meet resident's needs

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, tour of the physical plant of the facility and interviews conducted.
It is alleged that staff failed to administer resident’s medication as prescribed. Record review for resident (R1) reflect MAR from June 2022 – January 2023, medication doses given as prescribed. MAR, PRN and controlled/antibiotic drug records reveled no missed doses. MARs reflect that medication was given at the scheduled time per order indications. Records review indicates staff was following doctor’s orders as

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: 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-20230113141920

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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prescribed. Interview with 2 of 2 staff revealed that medication is given as prescribed and staff indicated this would reflect on MAR, but however dosages are signed off as given as indicated on prescription instructions. There are no obvious documentation errors to support that a violation has or has not occurred regarding allocation of medications.

It is alleged due to language barriers staff can’t communicate with residents. Interview with 2 of 2 staff indicated that all the care staff and med tech that have been hired since they have been employed spoke English and never had an issue with communications. Staff indicated that there has always been plenty of multi-cultural care staff/med tech but they have never heard of any resident having an issue with communication. Interview with 6 of 6 residents indicated that they have always been able to communicate with care staff and have never had an issue with being able to communicate with them. LPA toured the physical plant of the facility and observed care staff and med techs assisting residents and did not observed difficulty in doing so.

It is alleged insufficient staffing to meet residents’ needs. Interview with Executive Director indicated that the schedule has always been the same and the number of staff has not changed and has been the same. Care staff and med tech are scheduled per shift, and they all attend residents care needs regardless if they are caregivers or med techs. Records review revealed that the monthly caregiver staffing schedule reflected that there were 3 shifts per day and there can be anywhere from 3 to 6 caregivers per shift, the number varies depending on the shift. The file review reflects there can be 4 care staff and 2 med tech scheduled at the day shift of 7:00am to 2:00pm, PM shift is from 2:00pm to 10:00pm and there can be 4 care staff and 1 med tech, and NOC shift is from 10:00pm to 6:00am with 2 med techs and 1 care staff. Title 22 regulation 87411(a) Personnel Requirements-General states: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to

Continued on LIC9099-C

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)

Page: 2 of 3

Control Number 22-AS-20230113141920

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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perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment, and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.

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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