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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005730
Report Date: 03/23/2023
Date Signed: 06/30/2023 03:17:00 PM


Document Has Been Signed on 06/30/2023 03:17 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 & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:MERIDIAN AT ANAHEIM HILLS, THEFACILITY NUMBER:
306005730
ADMINISTRATOR:BOTTINELLI, SHEILAFACILITY TYPE:
740
ADDRESS:525 S ANAHEIM HILLS ROADTELEPHONE:
(714) 974-2226
CITY:ANAHEIMSTATE: CAZIP CODE:
92807
CAPACITY:120CENSUS: 78DATE:
03/23/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Analyn Samsong-Resident Care Director, Sheila Bottinelli-Executive DirectorTIME COMPLETED:
11:04 AM
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. made an unannounced collateral visit in conjunction with complaint 22-AS-20200819143438. LPA Ramirez was allowed entry into the facility and initially met with Resident Care Director (RCD) Analyn Samsong and explained the purpose of the visit. Executive Director (ED) Sheila Bottinelli arrived shortly after.

On today's visit at 9:38 a.m. LPA Ramirez toured the Assisted Living and interviewed staff. LPA was not able to reviewed and obtained copies of facility, resident, and staff records as facility does not have records from August of 2020. Per RCD Samsong there are no residents present today that were living at the facility in August of 2020.

An exit interview was conducted with RCD Samsong and a copy of this report was provided at the time of exit.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2023
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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