306004520-5-5-2022-22-AS-SSAS-CFU3JR-20220628181759

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004520
Report Date: 05/05/2022
Date Signed: 05/05/2022 11:51:10 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/22/2020 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200422163121

FACILITY NAME:	MERIDIAN AT LAGUNA HILLS		FACILITY NUMBER:	306004520
ADMINISTRATOR:	MALLIKA PURI		FACILITY TYPE:	740
ADDRESS:	24552 PASEO DE VALENCIA		TELEPHONE:	(949) 581-6111
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	150	CENSUS:	DATE:	05/05/2022
		UNANNOUNCED	TIME BEGAN:	11:22 AM
MET WITH:	Frederick Paoli		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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-Facility is unclean

-Facility staff failed to return resident's personal belongings.

-Facilioty staff failed to meet the 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 arrived at the facility was greeted and granted entry by receptionist. LPA met with Fred Paoli, Administrator and explained the purpose of the visit.

Findings are based upon this investigation which included interviews conducted, documentation review of the following: Admissions agreement, resident assessment, physician’s report, covid-19 precautionary notices.

It is alleged that facility is unclean. Based on the documentation reviewed for covid-19 guidelines facility implemented a daily housekeeping regiment that covered cleaning of all resident’s apartment as well as common areas which would include: all restrooms cleaned/disinfected daily and as needed throughout the
day, lobby, elevators and common seating area to be cleaned daily, daily vacuuming, sanitization of all

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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-20200422163121

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MERIDIAN AT LAGUNA HILLS	FACILITY NUMBER: 306004520
	VISIT DATE: 05/05/2022

NARRATIVE

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touchable surfaces including residents apartments and residents bathrooms cleaned daily. Facility to maintain a high level of cleanliness throughout the community by disinfecting frequently all touched objects and surfaces.
It is alleged facility staff failed to return resident’s personal belongings. Based on interviews it was stated that facility does not manage resident’s personal belongings. In review of admissions agreement it is stated removal of personal property if you fail to remove your personal property from the residence on or before the termination date, or within 10 days after your death, we may elect to remove your personal property from the residence and place in storage at your or your estate’s expense. Furthermore R1’s property was moved out by son on the day of move-out.

It is alleged the facility staff failed to meet the resident’s needs. Based on review of R1’s admissions agreement signature page indicates services level is assisted living basic services rate and on no level of care required. Attachment A basic services offered included: meals and snacks, care (Included in the Basic Services Rate are the following: observation for changes in functioning, notification to family and other appropriate persons/agency of your needs, and bedside care for minor temporary illness. Services may· also include assistance with bathing, grooming, dressing, assistance with prescribed medications and other personal services.), activities, common areas, parking, transportation, housekeeping services, laundry services, and emergency call and response system. In review of R1’s assessment it indicates facility was providing care needs in the following with the following: depression, fall risk due to R1 having moderate risk, minimal assistance with transfer only related to Parkinson’s, wardrobe assistance when needed secondary to Parkinson’s, and mild confusion but is generally cooperative can be disoriented to some spheres at times this services are included in the basic services. Interviews conducted with facility staff states R1’s daughter called and spoke to staff requesting for showers by caregivers. Daughter was told that R1 was not on any level of care plan however, facility accommodated to R1 with showers. R1 was reminded to use pendant or call button when needing assistance due to her Parkinson’s.

Based on the information gathered during the investigation, review of all documents obtained, 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 Administrator and a copy of this LIC9099 report was left at facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC9099 (FAS) - (06/04)

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