374603339-2-26-2024-18-AS-JDHS-D2VRNG-20240228121017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603339
Report Date: 02/26/2024
Date Signed: 02/26/2024 03:15:01 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/24/2024 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20240124163406

FACILITY NAME:	MERIDIAN AT LAKE SAN MARCOS, THE		FACILITY NUMBER:	374603339
ADMINISTRATOR:	FERLINA MCBRIDE		FACILITY TYPE:	740
ADDRESS:	1177 SAN MARINO DR BLDG 1 & 2		TELEPHONE:	(760) 510-7500
CITY:	SAN MARCOS	STATE: CA	ZIP CODE:	92078
CAPACITY:	170	CENSUS: 135	DATE:	02/26/2024
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Executive Director, Amy Banaga		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff financially abused resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit to the facility to deliver findings on a complaint investigation regarding the allegations listed above. LPA met with Administrator, Amy Banaga and explained the purpose of the visit and the elements of the allegations. LPA Banrasavong conducted the investigation which consisted of observations, interviews with staff members and residents, and record review. LPA was unable to interview S1 as LPA was unable to obtain contact.
On 01/24/2024, Community Care Licensing (CCL) received a complaint that alleged staff financially abused resident. It was reported that a facility staff member stole $900 from a resident (R1).
In regards to the allegation that facility staff financially abused resident, Resident 1 (R1) stated that they got a notification from their bank about a withdrawal of $900. R1 stated that they did not authorize that amount. R1 notified Administrator, Amy Banaga of the unauthorized withdrawal. R1 obtained a copy of the check and it revealed that the check was written out to an employee of the facility, Staff (S1).

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240124163406

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MERIDIAN AT LAKE SAN MARCOS, THE	FACILITY NUMBER: 374603339
	VISIT DATE: 02/26/2024

NARRATIVE

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The check was in the amount of $900 and “Happy Birthday” written in the memorandum area. Information obtained from Administrator Banaga stated that she contacted S1’s supervisor to advise of concerns and initiate an investigation. During the course of the investigation initiated by the facility, S1 initially stated that they received money as a gift from R1. S1 then admitted that they stole the check and wrote the check, signed it, and cashed it at a local check cashing location. LPA reviewed the written and signed statement submitted to HR and on file with the facility. LPA was also able to obtain termination paperwork for the employee. During an interview with R1, the information regarding the account was corroborated.

Based on observations and interviews, the preponderance of evidence standard has been met; therefore, the above allegation that the facility staff financially abused the resident is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 8 87468.2 (a) (4)), are cited on the attached LIC 9099D. Pursuant to Title 22 of The California Code of Regulations Division 6, there are one (1) deficiency that will be cited.

An exit interview was conducted. The report, along with the 9099D and appeal rights were reviewed and provided to the Administrator, Amy Banaga.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240124163406

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MERIDIAN AT LAKE SAN MARCOS, THE	FACILITY NUMBER: 374603339
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/15/2024 Section Cited HSC 87468.2(a)(4)	1 2 3 4 5 6 7	87468.2 (a) In addition to the rights...residents...shall have all of the following personal rights:4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.This requirement was not met, as evidenced by:	1 2 3 4 5 6 7	The Administrator, Amy Banaga stated that she will have all the staff review the regulation being cited and submit a signed affidavit, of the staffs' signature reading and understanding the regulation.
	8 9 10 11 12 13 14	Based on the LPA's record review, interviews, the facility staff (S1) was not competent, by stealing $900 from R1.	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: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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