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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005730
Report Date: 06/30/2023
Date Signed: 06/30/2023 03:17:42 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: 75DATE:
06/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Analyn Samsong-Resident Care DirectorTIME COMPLETED:
03:30 PM
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On this day Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. made an unannounced visit to reissue report dated 03/23/23 in conjunction with complaint 22-AS-20200819143438. LPA was greeted and granted entry into the facility and met with Resident Care Director (RCD) Analyn Samsong. LPA had to deliver report due a technical error.


An exit interview was conducted with 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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