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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603339
Report Date: 03/08/2024
Date Signed: 03/08/2024 11:58:28 AM


Document Has Been Signed on 03/08/2024 11:58 AM - 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:MERIDIAN AT LAKE SAN MARCOS, THEFACILITY NUMBER:
374603339
ADMINISTRATOR:FERLINA MCBRIDEFACILITY TYPE:
740
ADDRESS:1177 SAN MARINO DR BLDG 1 & 2TELEPHONE:
(760) 510-7500
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:170CENSUS: 124DATE:
03/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH: RESIDENT SERVICES DIRECTOR, JESSICA LANE.TIME COMPLETED:
12:08 PM
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On March 08, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted an unannounced annual required visit and met with Jessica Lane, Resident Services Director, who was informed of the purpose of the visit. The Facility File review was conducted in the Regional Office and additional forms were requested and reviewed on site.

LPA Mixson toured the facility, along with the Resident Services Director, and inspected the inside and outside of the facility. The facility is comprised of five buildings two of which are licensed for memory care and assisted living. Each building is three stories with total capacity of 170 residents, 170 of which may be non-ambulatory, and ten of which may be bedridden on the first floor only. The residents served are elderly ages 60 and above. The Facility is located at 1177 San Marino Dr San Marcos, CA. 92078, and the facility phone number is (760) 510-7500, and is operable.

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen. LPA Mixson observed gloves and cleaning supplies to do regular cleaning of the facility. The LPA reviewed the facility's infection control plan and found all required infection control measures. LPA Mixson observed PPE supplies at the facility. The LPA reviewed infection control training conducted with facility staff which met the department requirements.

Physical Plant/Planned activities: LPA Mixson observed the resident living units. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair and were present. The outdoor area was observed to be free of hazards. There is a pool that is locked with resident in assisted living having a key to access. The laundry room was observed to be locked. The hot water temperature was recorded and logged within regulations.

Food Service: LPA Mixson observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. The LPA observed the facility met the required two day supply of perishable and seven day supply of non-perishable foods. Care & Supervision: adequate per facility type and within the regulations.

Records Review: The LPA reviewed staff and resident files, conducted staff and residents interviews, and reviewed Previous Community Care Licensing forms. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was provided to Resident Service Director, Jessica Lane.

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2024
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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