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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004520
Report Date: 03/10/2025
Date Signed: 03/10/2025 08:32:01 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
12/21/2022 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221221195315
FACILITY NAME:MERIDIAN AT LAGUNA HILLSFACILITY NUMBER:
306004520
ADMINISTRATOR:FREDERICK M PAOLIFACILITY TYPE:
740
ADDRESS:24552 PASEO DE VALENCIA BLDG ATELEPHONE:
(949) 581-6111
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:0CENSUS: 210DATE:
03/10/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Eric Jensen- Executive Director
Maryann Bautista- Resident Care Coordinator
TIME COMPLETED:
08:32 AM
ALLEGATION(S):
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Staff leaves resident soiled for an extended period of time resulting in resident sustaining a rash.
Staff does not ensure resident is fed.
Staff does not ensure resident's medication is administered.
Staff does not ensure resident's hygiene needs are being met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) arrived unannounced to deliver the findings into the above allegations. LPA met with Executive Director (ED) Eric Jensen and stated the purpose of the visit. On December 21, 2022, the Department received the complaint, and the investigation was initiated on December 28, 2022. During the course of the investigation, LPA interviewed Resident #1 (R1), four staff, and two hospice staff. Pertinent documentations were obtained which includes the Resident Roster, Personnel Report, Shift Log, R1’s Face Sheet, Identification and Emergency Information (LIC601), Advance Health Care Directive, Physician’s Report, Preplacement Appraisal Information, Resident Assessment, Care Plan, Admission Agreement, and medical records.

Regarding the allegations, Staff leaves resident soiled for an extended period of time resulting in sustaining a rash, Staff does not ensure resident is fed, Staff does not ensure resident’s medication is administered, and...
[Continued on LIC9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 22-AS-20221221195315
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: 03/10/2025
NARRATIVE
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Staff does not ensure resident’s hygiene needs are being met, the investigation revealed the following:
On March 19, 2012, R1 was admitted to the facility and into hospice on October 20, 2021, due to a progressing terminal illness of Myasthenia Gravis (MG) without Acute Exacerbation. R1 passed away on February 23, 2023, per Death Report dated March 1, 2023. R1 developed multiple pressure injuries with the first wound onset at stage 2 affecting the coccyx on September 13, 2022, per medical records. Per Title 22, 87631 Healing Wounds, regulation states that a physician or an appropriately skilled professional provides care to a resident with a stage one or two pressure injury. Based on the review of the medical records, wound care was treated by hospice. Based on the interviews, R1 did not corroborate with the allegation indicating that the pressure wound was expected due to R1 being “off their feet for 4-5 years.” R1 expressed receiving good care and confirmed receiving diaper changes 2-3 times and as needed by facility staff. Three out of the four facility staff denied the allegation stating R1’s diaper was changed at least 2-3 times per shift and more. The remaining staff could not provide information regarding R1’s care as they were not assigned to work with R1. Based on the review of the Physician’s Report dated May 17, 2018, R1 was able to care for their own toileting needs and does not require continuous bed care. Resident Assessment dated December 28, 2022, reveals R1 requiring a standby assist with toileting. It appears that the facility did not have a procedure to document diaper changes for all residents. Hospice staff indicated during the interview R1 declined for increased care due to additional cost.

Based on LPA’s observation of R1 during the visit conducted on December 28, 2022, R1 was alert and oriented, sitting upright in bed, and having their breakfast at 11:45am. The lunch tray was delivered approximately 12:10pm. LPA observed R1 was able to carry a conversation while independently having their meal which aligns with the findings on the Physician’s Report and on the Resident Assessment. Based on the interviews, three out of the four staff indicated that meals were delivered timely and R1 being able to feed self independently. R1’s primary caregiver indicated that food would be reheated as needed when R1 did not have an appetite. LPA observed the medications in R1’s room. Based on LPA’s observations, R1 demonstrated understanding the need for their medications, time, and quantity. R1 indicated that they manage their own medications. Per Physician’s Report and Resident Assessment, R1 self-administers their own meds also corroborated by three out of the four staff. Regarding hygiene care, R1 received showers from a hospice staff twice a week as noted on the Resident Assessment. R1 confirmed receiving showers every Tuesdays and Fridays and sponge baths by facility staff. Three out of the four staff denied the allegation. R1’s primary caregiver indicated that sponge baths were provided daily.
[Continued on LIC9099-C]
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 22-AS-20221221195315
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: 03/10/2025
NARRATIVE
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Therefore, based on the observations made, interviews which were conducted and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations noted are deemed UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Eric Jensen, and a copy of this report including the LIC811 were provided at the end of the visit.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3