306005730-9-18-2024-22-AS-JALE-D9933X-20240918175416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005730
Report Date: 09/18/2024
Date Signed: 09/18/2024 05:54:23 PM

Document Has Been Signed on 09/18/2024 05:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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: 72	DATE:	09/18/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	Raymond Pellicer		TIME COMPLETED:	05:45 PM

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 Analysts (LPAs) Joseph Alejandre and William Vanegas made an unannounced visit to conduct the required annual inspection. LPAs met with the Executive Director Raymond Pellicer and explained the reason for the visit. The facility has a main lobby and 4 separate wings and each wing has multiple floors. There is a fountain outside the main entrance of the facility. The facility has a memory care unit with delayed egress. LPAs observed the main stairway in the lobby did not have an evacuation chair. LPAs observed there are numerous shaded area with tables and chairs outside the facility for residents to sit outside. LPAs and the Executive Director toured the facility. LPAs observed the emergency food and water is stored in a supply closet. LPAs and the Executive Director toured the kitchen and dining room. LPAs observed the dining room is clean and organized. LPAs observed there is a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPAs observed both refrigerators and freezers had temperature logs posted on the doors. LPAs toured 8 resident rooms. LPAs observed all resident bathrooms in the rooms inspected were clean and operational. Hot water measured between 116.6 and 112.2 degrees Fahrenheit in the rooms inspected. LPAs observed all resident rooms had the required furnishings. LPAs observed multiple rooms for activities and social gatherings. The fireplace in the upstairs living room (plaza lounge) is screened. LPAs observed the See Something, Say Something poster posted on the second floor in a hallway. LPAs observed residents having an ice cream social in the upstairs living room. LPAs and the Executive Director toured memory care. LPAs observed residents participating in a sing a long. LPAs observed emergency evacuation chairs in each stairwell. LPAs observed the signal system in the memory care unit is not operational in any of the 19 rooms. The Executive Director verified the signal system in memory care is not operational. LPAs verified the signal system in assisted living is operational. LPAs observed the delayed egress exits in memory care are operational. LPAs observed the medication is kept locked in a medication cart in the medication room. LPAs interviewed staff and residents. LPAs reviewed 5 staff files. All staff interviewed during the visit and staff members who's files were reviewed are background cleared and associated to the facility. LPAs observed that 1 out of 5 staff members (Staff 4) did not have the required 20 hours of annual training. LPAs reviewed 7 resident files and medications.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

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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Document Has Been Signed on 09/18/2024 05:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MERIDIAN AT ANAHEIM HILLS, THE	FACILITY NUMBER: 306005730
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(i)(1)(A)

Maintenance and Operation

(i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (A) Operate from each resident's living unit. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation LPAs observed the 19 rooms in the memory care unit did not have a working signal systme which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/16/2024
	Plan of Correction
1 2 3 4	Licensee agrees to have the signal system repaired or replaced in the 19 rooms in memory care by the POC due date.

Type B

Section Cited

HSC

1569.625(b)(2)

Other Provisions

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 5 staff members (Staff 4 only had 12.5 hours of training) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/02/2024
	Plan of Correction
1 2 3 4	LIcensee agrees to have Staff 4 trained to meet the 20 hours of annual training and to submit proof to LPA by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MERIDIAN AT ANAHEIM HILLS, THE	FACILITY NUMBER: 306005730
	VISIT DATE: 09/18/2024

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 26 27 28 29 30 31 32	No discrepancies observed. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report along with appeal rights was provided.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC809 (FAS) - (06/04)

Page: 5 of 5