306005804-8-5-2024-22-AS-RMAZ-D7UTWT-20240805150605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005804
Report Date: 08/05/2024
Date Signed: 08/05/2024 03:06:17 PM

Document Has Been Signed on 08/05/2024 03:06 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 LAGUNA HILLS, THE		FACILITY NUMBER:	306005804
ADMINISTRATOR:	ROSSI, MARIA		FACILITY TYPE:	740
ADDRESS:	24552 PASEO DE VALENCIA BLDG A		TELEPHONE:	(949) 581-6111
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	200	CENSUS: 76	DATE:	08/05/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Maria Rossi		TIME COMPLETED:	01:00 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 Analyst (LPA) Ruth Martinez made an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at the facility was greeted by receptionist and granted entry. LPA met with Maria Rossi, Executive Director. An initial application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (200) capacity, (0) ambulatory, (185) non-ambulatory, and (15) bedridden residents was submitted to CCL on 03/05/2020. Structure: The facility is a two building facility, building A & B. The facility has independent living in building B and assisted living in building A floors 1-5 only. Facility has carports, garage and open assigned parking for residents’ vehicles. The facility has 122 apartment style bedrooms. A dining room in the 1st floor and 2^nd floor of building A, 1 spa, 1 salon, 1 fitness center, I med room and 2 common space activities/movie rooms, and a restaurant style open kitchen. The resident’s apartment bedrooms are spacious and will easily accommodate the resident’s furnishings. There is shaded outdoor space in the front of the building, outside adjacent to first floor dining room, a putting green by building B and a gated pool by building B that assisted living residents can access. Signal system: Residents utilize pendant alert system for requesting assistance. Pendant alarm system triggers a signal to a pager system. Bedrooms Residents: Bedrooms are designed as an individual apartment for 0 ambulatory, 185 non-ambulatory and 15 bedridden residents. Bedrooms will accommodate 1 resident unless it is a couple with a private bathroom. Bedridden residents can be in floors Continued on LIC809-C

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024

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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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 LAGUNA HILLS, THE	FACILITY NUMBER: 306005804
	VISIT DATE: 08/05/2024

NARRATIVE

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1-4 only of building A. Bedrooms Staff: No live in staff. Bathrooms: Resident have their own bathroom in their apartments. Facility has common bathrooms as well. All bathrooms have a working toilet, wash basin, bath-tub/shower. Linens & Hygiene Supplies: Adequate supply of linen stored in facility storage unit. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are to be stored in the kitchen with surplus goods stored in kitchen. Smoke Detectors: Facility has a fire panel in the reception area, smoke detectors, sprinklers and carbon monoxide alert systems are tested and maintained by an outside vendor and conduct yearly inspections. Fire panel last inspection was 3/13/24, sprinklers last tested on 4/24/24, smoke detectors last tested 6/24/24-6/28/24. Appliances: Residents apartments have small kitchen, with refrigerator, microwave and small sink. Facility main kitchen on the 1^st floor is equipped with ovens/ranges/microwaves, prep counters, refrigeration, freezer, grill, steam tables, ice makers, washer, and dryer (on each floor) are clean and noted to be operational. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to resident are stored and locked in a storage unit. Water Temperature: Tested and recorded the water temperature measures 109.4 – 117.3 Fahrenheit degrees in all resident apartments and common bathrooms on floor 1-5 in building A. Medications, First-Aid Kit & Book: Medication, first aid and book are stored in med room inaccessible to residents. First aid kits are also mounted in a glass container locked in hallways, kitchen and common spaces throughout the facility. Resident & Staff Files: Records for staff and residents are in business office and resident medication files are stored in med room. Pool: Gated pool behind building B, assisted living resident have access to pool. Gate measures 5ft from base to the top of the fence. Fire Extinguisher: Mounted in wall throughout each floor dated 6/19/24. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the residents use, commensurate with the plan of operation. Fire clearance: Was approved on 5/30/24. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities.

The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Exit interview was conducted and a copy of this report was left with the applicant.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024

LIC809 (FAS) - (06/04)

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