306005460-12-2-2022-22-AS-SSAS-CLY3WF-20221209173640

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005460
Report Date: 12/01/2022
Date Signed: 12/02/2022 10:16:21 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
10/28/2020 and conducted by Evaluator Michelle Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201028094027

FACILITY NAME:	MERIDIAN AT ANAHEIM HILLS, THE		FACILITY NUMBER:	306005460
ADMINISTRATOR:	BOTTINELLI, SHELIA		FACILITY TYPE:	740
ADDRESS:	525 S. ANAHEIM HILLS ROAD		TELEPHONE:	(714) 974-2226
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92807
CAPACITY:	0	CENSUS: 0	DATE:	12/01/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Facility Closed		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Lack of supervision led to resident's fall from wheelchair
Facility unable to meet needs of resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michelle Reed delivered findings via certified mail to Licensee address at 1775 Hancock St. Suite 200 San Diego, CA 92110. Facility has been closed since 9/22/20.

Resident #1 (R1) was admitted into the Memory Care unit of the facility on 10/4/20. R1 was nonambulatory and had a Dementia diagnosis. R1 needed assistance with all ADL's. On 10/20/20 R1 had a witnessed fall in the bathroom and hit his head. According to interviews and documentation, his legs buckled. 911 was called and R1 returned back to the facility the same day. Resident was to be placed on hospice. On 10/22/20, R1 had another fall in the dining room while sitting in his wheelchair. R1 stood up and fell sideways and received a head laceration. 911 was called and R1 was taken to hospital. R1 did not return to the facility and passed away at the hospital on 10/24/20.

Based upon staff interviews and a review of records, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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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