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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603339
Report Date: 06/22/2022
Date Signed: 06/22/2022 11:21:25 AM


Document Has Been Signed on 06/22/2022 11:21 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,
, CA



FACILITY NAME:MERIDIAN AT LAKE SAN MARCOS, THEFACILITY NUMBER:
374603339
ADMINISTRATOR:QUIGLEY, KEVINFACILITY TYPE:
740
ADDRESS:1177 SAN MARINO DR BLDG 1 & 2TELEPHONE:
(760) 510-7500
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:170CENSUS: 140DATE:
06/22/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Resident Service Director Teresa RobertsTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced collateral visit on this date to continue an investigation that is unrelated to this facility. The purpose of the visit was to conduct an interview with a resident that is pertinent to the investigation. LPA met with Resident Service Director Teresa Roberts, discussed the purpose of the visit.

During today's visit, LPA conducted an interview with a resident.

An exit interview was conducted and and a copy of this report, as well as the Licensee Rights (LIC 9058 1/16), was provided to Resident Service Director Teresa Roberts.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby StrongTELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2022
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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