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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004520
Report Date: 11/03/2022
Date Signed: 11/03/2022 11:45:11 AM


Document Has Been Signed on 11/03/2022 11:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 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:150CENSUS: 84DATE:
11/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Frederick PaoliTIME COMPLETED:
12:00 PM
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On 11/03/2022 at 9:18am, Licensing Program Analyst (LPA) Jessica Cho arrived at Meridian at Laguna Hills to conduct an unannounced visit. The purpose of today's visit was to conduct a Required 1 Year with an emphasis on Infection Control. At 10:13am, LPA Cho was greeted and granted entry by Receptionist Jazmin Saldana. LPA completed the Coronavirus 2019 (COVID-19) screening procedure and met with Executive Director (ED) Frederick Paoli approximately around 9:25am. There are no active COVID-19 cases as of today. LPA observed a check-in station that required a COVID-19 screening/questionnaire for all visitors. LPA observed the required COVID-19 precautionary signs posted throughout the facility. The Complaint Poster (PUB475) met the size requirement. The facility is licensed for one-hundred eighteen non-ambulatory residents and has a hospice waiver for thirty. There are currently eighty-four residents living in the facility of which eleven are receiving hospice care.

At 10:50am, LPA Cho conducted a tour of the physical plant with ED Frederick Paoli. LPA observed all the common areas and randomly selected and inspected the resident bedrooms. The resident bedrooms had the required furnishings. The resident bathrooms were checked. Grab bars were secure, the toilets worked properly, the showers were free of mold/mildew, and non-skid mats were in place. Resident bath towels and personal hygiene supplies were adequately stocked with hand soaps. LPA did not observe hand washing signs in the public bathrooms on levels 2-5. Perishable and non-perishable food supplies were checked and adequately stocked at the time of the visit. The fire extinguishers were mounted, fully charged, and serviced on 06/20/2022. Smoke detectors were tested on 01/25/2022 by VFS Fire & Security Services and were not operational and is pending authorization by the Orange County Fire Authority to replace the fire control panel. Medications, toxins, and sharps were locked and inaccessible to the residents. LPA Cho toured the outside grounds. The swimming pool was secured. There was shading and sufficient seating for residents. Walkways around the facility were clear of hazards, and LPA observed sufficient supply of emergency food/water and PPEs.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/03/2022
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Based on the observations made during today's visit, no deficiency is cited in this review as per Title 22 Division 6 of the California Code of Regulations. Advisory Notes (LIC9102) were issued during the visit. An exit interview was conducted with Executive Director Frederick Paoli, and a copy of this report was provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
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