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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005804
Report Date: 11/01/2022
Date Signed: 11/01/2022 12:50:48 PM

Document Has Been Signed on 11/01/2022 12:50 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MERIDIAN AT LAGUNA HILLS, THEFACILITY NUMBER:
306005804
ADMINISTRATOR:PAOLI, FREDFACILITY TYPE:
740
ADDRESS:24552 PASEO DE VALENCIATELEPHONE:
(949) 581-6111
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: 200CENSUS: 83DATE:
11/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Fred PaoliTIME COMPLETED:
01:00 PM
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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 Fred Paoli, Administrator.

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 2nd 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 dinning 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 the wellness office.

Continued on LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 LAGUNA HILLS, THE
FACILITY NUMBER: 306005804
VISIT DATE: 11/01/2022
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Bedrooms Residents:
Bedrooms are designed as an individual apartment for 0 ambulatory, 185 non-ambulatory and 15 bedridden. Bedrooms will accommodate 1 resident unless it is a couple with a private bathroom.

Bedrooms Staff:
No live in staff

Bathrooms:
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:
Smoke detectors, sprinklers and carbon monoxide alert systems are tested and maintained by an outside vendor named VFS Fire and Safety.

Appliances:
Residents apartments have small kitchen, with refrigerator, microwave and small sink. Facility main kitchen on the 1st 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.

Continued on LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 LAGUNA HILLS, THE
FACILITY NUMBER: 306005804
VISIT DATE: 11/01/2022
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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 105.8 – 115.8 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.

Resident & Staff Files:
Records for staff and residents are in business office and resident medication files are stored in med room.

Pool/Jacuzzi & Pets:
Gated pool behind building B, assisted living resident have access to pool.

Fire Extinguisher:
Mounted in wall on each floor dated June 20, 2022.


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.

Continued on LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 LAGUNA HILLS, THE
FACILITY NUMBER: 306005804
VISIT DATE: 11/01/2022
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Fire clearance:
Was approved on 10/29/2021.

Component III:
Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance.

Facility appears to be ready for licensure in all areas inspected. Accordingly, LPA will submit file for approval to CCL Supervisor. Exit interview was conducted and a copy of this report was left with the applicant.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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