306005730-11-16-2022-22-AS-SSAS-CNUPV3-20230208103829

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005730
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:54:49 PM

Substantiated

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
08/20/2021 and conducted by Evaluator Michelle Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210820134614

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: 73	DATE:	11/16/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sheila Botinelli		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained a fall while in care
Resident was left on the floor for an extended period of time

INVESTIGATION FINDINGS:

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Licensing Program Analyst Michelle Reed arrived at the facility to deliver the findings of this complaint investigation. LPA met with Administrator Sheila Botinelli. The complaint was investigated and consisted of interviews with the facility staff, Administrator and witnesses. The following was determined:

Resident #1(R1) was admitted into the facility on 7/2/21 was nonambulatory and required 1 person total assistance with all her activities of daily living. R1's care plan disclosed that she was to be status checked every 2 hours or 4 times per shift. On 8/12/21, sometime in the early morning hours, R1 had a fall in her bathroom and stated that she was on the floor for approximately an hour. Staff on the NOC shift were unaware of the fall and R1 contacted 911 herself. R1 was admitted into the hospital at approximately 4:00am. At 6:00am the morning staff noted that R1 was not in her room. Staff #1 contacted Kaiser Hospital and was told that R1 was admitted. Documents and interviews disclosed that R1 was last checked on at 11:00pm on 8/11/21.

Substantiated

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: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 22-AS-20210820134614

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 11/16/2022

NARRATIVE

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Based upon interviews and the records reviewed, the preponderence of evidence standard the preponderance of evidence standard has been met and the allegations are substantiated. Staff were unaware of R1's fall and that R1 had called the paramedics and went to the hospital.

See LIC9099D for cited deficiencies.

An exit interview was conducted with Executive Director Sheila Botinelli and a copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20210820134614

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/17/2022 Section Cited CCR 87464(f)(1)(c)	1 2 3 4 5 6 7	Basic Services-Basic services shall at a minimum include Care and Supervision as indicated in the pre-admission appraisal and resident assessment. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee immediately inserviced staff on the occurrence and the importance of status checks. Staff #2 was suspended and did not return to employment.
	8 9 10 11 12 13 14	On 8/12/21 in the early morning hours, R1 fell and contacted 911 herself. Staff were not aware that R1 had gone to the hospital until approximately 6am when they discovered R1 was not in her room. This posed an immediate health and safety/personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC9099 (FAS) - (06/04)

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