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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603339
Report Date: 04/10/2023
Date Signed: 04/10/2023 02:37:25 PM


Document Has Been Signed on 04/10/2023 02:37 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



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: 143DATE:
04/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Executive Director, Rob JohnstonTIME COMPLETED:
02:45 PM
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Licensing Program Analysts (LPAs) Janira Arreola and Jacqueline Shaw Ross conducted an unannounced annual required visit on 4/10/2023 at 10:00 a.m. LPA met with Administrator Rob Johnston, who was informed of the purpose of the visit.

The facility is comprised of (5) buildings (2) of which are licensed for memory care and assisted living. Each building is (3) stories with total capacity of (178) residents, (178) of which may be non-ambulatory, and (10) of which may be bedridden on the first floor only. The residents served are elderly ages 60 and above. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted (5)staff and (5)resident interviews. LPA observed the following:

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen. LPA observed gloves and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures. LPA 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 observed the resident bedrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair 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. Laundry room was observed to be locked and equipment was observed to be in working condition. Hot water temperature was recorded at 110.3F.

Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, THE
FACILITY NUMBER: 374603339
VISIT DATE: 04/10/2023
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Care & Supervision/Administration: LPA observed adequate staff are present for the supervision of residents. Emergency exiting plans, personal rights, ombudsmen, and complaint information were found posted in the facility. The listed administrator, possesses a current administrator's certificate. The administrator presented the LPA with documents they sent to the department within the 30 day requirement to change administrators. LPA will inquire about the request. LPA reviewed the facility's liability insurance and found that that it was current.

Record Review and Resident/Staff Files: LPA reviewed (5) staff files. All staff have updated training along with CPR/First Aid Certification. Five (5) resident files were reviewed, and found all required documents were present.

Health Related Services/ Incidental Medical Services: All client medications were locked in a medication cart. LPA reviewed resident medications and found all required labeling was found to be in place and all medication was accounted for. LPA observed the facility has a first aid kit on the premises with all required articles.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility last disaster drill on 3/28//2023, which met the department requirements. LPA observed all facility exits, and evacuation routes were posted at the facility. LPA observed the facility's emergency supplies and LIC610D along with disaster preparedness binder.

No deficiencies were cited at the time of the visit.

An exit interview was conducted where a copy of this report was reviewed and provided to Administrator, Rob Johnston.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
LIC809 (FAS) - (06/04)
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