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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603339
Report Date: 03/30/2025
Date Signed: 03/30/2025 03:05:29 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
10/20/2023 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 18-AS-20231020143409
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: 100DATE:
03/30/2025
UNANNOUNCEDTIME BEGAN:
08:07 AM
MET WITH:Melissa SigalaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff does not keep an accurate medication log.
INVESTIGATION FINDINGS:
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On 03/30/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a subsequent complaint visit to the facility listed above. LPA met with Memory Care Director, Melissa Sigala, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

The investigation consisted of the following:
On 10/26/2023, LPA Kathleen Banrasavong conducted an initial visit. The visit consisted of a facility tour, interiew with Administrator and review of facility record, and collected pertinent documents.
During a subsequent visit conducted on 03/29/2025, LPA Gibbs toured the facility, interviewed Staff S4-S8, interviewed Residents R3-R7, and received copies of Staff S1 employee file.
During today’s visit, LPA Gibbs interviewed Staff S9 and S10 and interviewed Resident R8-R12.

The investigation revealed:
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (530) 966-1801
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
10/20/2023 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 18-AS-20231020143409

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: 100DATE:
03/30/2025
UNANNOUNCEDTIME BEGAN:
08:07 AM
MET WITH:Melissa SigalaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff stealing residents medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/30/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a subsequent complaint visit to the facility listed above. LPA met with Memory Care Director, Melissa Sigala, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

The investigation consisted of the following:
On 10/26/2023, LPA Kathleen Banrasavong conducted an initial visit. The visit consisted of a facility tour, review of facility record, interviewed staff, and collected pertinent documents.
During a subsequent visit conducted on 03/29/2025, LPA Gibbs toured the facility, interviewed Staff S4-S8, interviewed Residents R3-R7, and received copies of Staff S1 employee file.
During today’s visit, LPA Gibbs interviewed Staff S9 and S10 and interviewed Resident R8-R12.

The investigation revealed:
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (530) 966-1801
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20231020143409
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MERIDIAN AT LAKE SAN MARCOS, THE
FACILITY NUMBER: 374603339
VISIT DATE: 03/30/2025
NARRATIVE
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Allegation: Staff stealing resident medication.
The allegation alleges that staff is stealing residents’ medication.

During record review, LPA reviewed the Medication Administration Records (MAR) and Physician’s Orders for 10 residents. During the facility tour LPA inspected the medication room and reviewed the MAR and medications for 10 residents. LPA observed eight (8) out of ten (10) resident medications are consistent with properly documented records. LPA reviewed 15 residents Controlled Drug Administration Record and conducted a Narcotic Drug pill count. LPA observed fifteen (15) out of fifteen (15) Controlled Drug Administration Record and pill count are consistent with properly documented records.


During interviews with Staff S3-S10, were asked if they suspect, seen, or heard of staff stealing medications, three (3) out of eight (8) stated they had heard a while ago that a staff might be stealing resident’s narcotics, but nothing recently.
During interviews with Residents R3- R12, were asked if they had any concerns if staff were stealing their narcotics, ten (10) out of ten (10) stated they have no concerns of staff taking their narcotics.

During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Memory Care Director, Melissa Sigala, and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (530) 966-1801
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 18-AS-20231020143409
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MERIDIAN AT LAKE SAN MARCOS, THE
FACILITY NUMBER: 374603339
VISIT DATE: 03/30/2025
NARRATIVE
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Allegation: Staff does not keep an accurate medication log.
The allegation alleges that staff changes the medication count on the medical log and they not accurate.

During Staff File review, LPA reviewed a Separation Form for S1, indicating an Involuntary Termination for Violation of company Policy effective 09/13/2024. Additionally, LPA reviewed a Suspension Notice for S1 dated 09/10/2024, pending an investigation. LPA reviewed an Employee Counseling Report dated 01/09/2024 for an incident that occurred on 12/05/2023. On 12/05/2023 there was a report of a discrepancy in the Controlled Substance count. The count sheet noted 10 pills and the bubble pack had 9 pills. During record review, LPA reviewed the Medication Administration Records (MAR) and Physician’s Orders for 10 residents. During the facility tour LPA inspected the medication room and reviewed the MAR and medications for 10 residents. LPA observed eight (8) out of ten (10) resident medications are consistent with properly documented records. LPA reviewed 15 residents Controlled Drug Administration Record and conducted a Narcotic Drug pill count. LPA observed fifteen (15) out of fifteen (15) Controlled Drug Administration Record and pill count are consistent with properly documented records.


During interviews with Staff S3-S10, were asked if they have observed any discrepancies on the Controlled Drug Administration Record , four (4) out of eight (8) stated they have observed discrepancies on the Controlled Drug Administration Record.
During interview with Residents R3-R12, were asked if they believe staff keep accurate documentation of their medications taken, ten (10) out of ten (10) stated they believe staff keep accurate records of their medications taken.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (530) 966-1801
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20231020143409
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MERIDIAN AT LAKE SAN MARCOS, THE
FACILITY NUMBER: 374603339
VISIT DATE: 03/30/2025
NARRATIVE
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During the course of the investigation, LPA was able to find evidence to support the allegation. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D.

An exit interview was conducted with Memory Care Director, Melissa Sigala, and a copy of this report and the Appeal Rights were provided.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (530) 966-1801
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20231020143409
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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: 03/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/09/2025
Section Cited
CCR
87506(a)
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87506 Resident Records (a)The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
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Adminsitrator will conduct an In-Service for Med Tech and review proper documentation for Medication Administration. Logs for the in-service will be emailed to LPA Gibbs by the POC date.
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Based on observation, record review, and interviews S1 had Employee Counseling Report due to discrepancies in Controlled Drug Administration Record and during file review, LPA observed 2 out of 10 were not consist with properly documented records.
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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: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (530) 966-1801
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6