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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005730
Report Date: 08/17/2020
Date Signed: 08/20/2020 07:47:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS 8-3-91
SACRAMENTO, CA 95814
FACILITY NAME:MERIDIAN AT ANAHEIM HILLS, THEFACILITY NUMBER:
306005730
ADMINISTRATOR:BOTTINELLI, SHEILAFACILITY TYPE:
740
ADDRESS:525 S ANAHEIM HILLS ROADTELEPHONE:
(619) 296-9000
CITY:ANAHEIMSTATE: CAZIP CODE:
92807
CAPACITY:120CENSUS: 80DATE:
08/17/2020
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sheila BottinelliTIME COMPLETED:
10:24 AM
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Facility Type: RCFE
Application Type: Change of ownership
Applicant/administrator participated in COMP II via call with analyst at CAB. Identification of the applicant and administrator was verified. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB.
During COMP II, CAB analyst confirmed Applicant/administrator’s understanding of following areas:
1.Facility operation: License type, client/resident populations, and program
2.Staff qualifications and responsibilities
3.Applicant and Administrator qualifications
4.Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions
5.Grievances, Complaints, Community resources
6.Physical plant, food service
SUPERVISOR'S NAME: Jude De La ConcepcionTELEPHONE: (916) 651-7841
LICENSING EVALUATOR NAME: Bethany HunterTELEPHONE: (916) 651-3571
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2020
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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