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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004520
Report Date: 11/08/2022
Date Signed: 11/08/2022 11:44:50 AM


Document Has Been Signed on 11/08/2022 11:44 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:
11/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Fred PaoliTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA) Ruth Martinez made an unannounced site visit to the facility on this date for the purpose of delivering an amended report originally issued on 07/12/2022.

In order for report to reflect additional complaint investigation information and determinations of findings.

Exit interview was conducted with Administrator and a copy of this LIC809 report was left with the Administrator, along with copies of amended reports.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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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