306005730-9-24-2020-22-AS-MRED-BTRKXW-20200924081812

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005730
Report Date: 09/22/2020
Date Signed: 09/24/2020 08:18:22 AM

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 ANAHEIM HILLS, THE		FACILITY NUMBER:	306005730
ADMINISTRATOR:	BOTTINELLI, SHEILA		FACILITY TYPE:	740
ADDRESS:	525 S ANAHEIM HILLS ROAD		TELEPHONE:	(714) 974-2226
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92807
CAPACITY:	120	CENSUS: 68	DATE:	09/22/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator Sheila Botinelli		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Michelle Reed conducted an announced visit to the facility for purpose of an announced Pre-Licensing visit via FaceTime due to the Coronavirus Pandemic and precautionary measures. An initial application for a Change of Ownership was submitted to the Central Applications Bureau (CAB) on 11/14/19 for a capacity of 60 ambulatory and 60 non-ambulatory residents of which 15 may be bedridden. LPA Reed conducted a virtual tour of the facility at approximately 10:15 am with Administrator Sheila Botinelli. and observed the following: Structure: The 525 address has two structures that are joined by a bridge. There are 4 wings throughout the facility. Wing A and B are designated for Independent residents. Wing C has Assisted Living on the 1st and 2nd floor as well as the Assisted Living dining room. The 3rd and 4th floor are Independent living. Wing D has Memory Care on the 1st floor, Assisted Living and Assisted Living Activity room on the 2nd floor and Independent living on the 3rd floor. Living Room/ Dining Room: Adequate seating is available in the dining room and living room as well as the activities room. There is a dining room and living room in the locked memory care unit. Bedrooms Residents: All resident bedrooms are currently set up for double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. A call system was in place for resident rooms. Bathrooms: Resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars. Linens & Hygiene Supplies: Linen supply is in ample supply for residents in care. Hygiene supplies were observed. Emergency Phone Numbers and Exit Plan: Available for review. Food Service: Facility has a supply of 2 day perishables as well as 7 day non-perishables in the main kitchen. LPA observed a posted a menu in the facility. Smoke Detectors: Smoke detectors are centrally wired and are tested by an outside company. Fire extinguishers are mounted and charged. Carbon monoxide detectors are operational. Toxins: LPA observed no unsecured toxins in the facility in the areas toured.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 748-2936
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020

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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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 ANAHEIM HILLS, THE	FACILITY NUMBER: 306005730
	VISIT DATE: 09/22/2020

NARRATIVE

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Reading Material, Games, and Equipment: LPA observed an activity schedule posted including activities. Outside Areas: LPA observed ample shaded seating in outside patios on the assisted living side as well as the memory care unit. Fire Clearance: Approved on 5/18/2020 for 60 ambulatory residents and 60 non- ambulatory residents of which 15 may be bedridden. Bedridden residents are allowed on the first floor only. Non-ambulaotory residents are allowed on first and second floors only in all wings. LPA reviewed the emergency disaster plan, back-up food supply and water. Medications, First-Aid Kit & Book: First aid kit observed in the medication room. Medication is stored and locked in medication carts located in the medication room. Resident & Staff Files: Records are secured in locked rooms.

Component III:
The applicant administrator has completed a Component III, therefore, the Component III will be waived during today’s visit.

The Pre licensing is complete and no corrections are needed.

The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau.

An exit interview was conducted with Sheila Botinelli and a copy of this report was provided via email. An electronic email read receipt, confirms receiving these documents. Mrs. Botinelli agreed to receive the copies of the report and to return a signed copy.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 748-2936
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020

LIC809 (FAS) - (06/04)

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