306005730-3-12-2025-22-AS-MSTC-DES3E2-20250314181027

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005730
Report Date: 03/12/2025
Date Signed: 03/12/2025 09:43:50 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/31/2024 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240731103344

FACILITY NAME:	MERIDIAN AT ANAHEIM HILLS, THE		FACILITY NUMBER:	306005730
ADMINISTRATOR:	BOTTINELLI, SHEILA		FACILITY TYPE:	740
ADDRESS:	525 S ANAHEIM HILLS ROAD		TELEPHONE:	(714) 974-2226
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92807
CAPACITY:	120	CENSUS: 196	DATE:	03/12/2025
		UNANNOUNCED	TIME BEGAN:	07:15 AM
MET WITH:	Executive Director, Raymond Pellicer		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff leave the residents unattended for an excessive amount of time
Staff are not providing adequate care and supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre met with Executive Director Raymond Pellicer for the purpose of delivering findings for the above allegations. The complaint consisted of record review, observations and interviews.

On July 31, 2024 the department received allegations that staff leave the residents unattended for an excessive amount of time and staff are not providing adequate care and supervision. The investigation was completed by the Department and revealed the following:
Based off records review, facility Staff work schedule dated between July 28, 2024 to August 24, 2024 shows that facility has 26 staff members working four shifts throughout the day. Each shift has at least six staff per shift for the exception of PM shift which has only two staff per shift.

Facility incident report dated June 4, 2024 regarding an unwitnessed fall for resident 1 (R1) states that during morning rounds a staff member heard R1 yelling for help, CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

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 22-AS-20240731103344

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MERIDIAN AT ANAHEIM HILLS, THE	FACILITY NUMBER: 306005730
	VISIT DATE: 03/12/2025

NARRATIVE

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to which staff member assisted R1 after finding resident on floor by kitchen area. Staff assessed R1’s skin tear on left leg and administered pain meds. Facility staff contacted responsible parties and R1 requested to return to room. R1 later that same morning complained of pain, was reassessed by staff and was sent out to St. Joseph hospital for further evaluation.

Facility In Service training log dated from January to July of 2024 documents that facility staff have had on site training's for the following areas of care: fall prevention, colostomy care, fatigue, depression, reporting change of condition, diabetes, and preventing injury using proper body mechanics of lifting & transferring.

The Facility Residence and Care Agreement documents the types of care services provided to residents such as Living accommodations, laundry, housekeeping, personal supplies, meals, planned activities, transportation, emergency response and fire protection, consultation, round the clock staffing, incontinence care and dementia services. The Care Agreement also covers additional areas of care such as “change of level of care”, “responsibility with yourself” and “risk of falls”.

LPA Tirre contacted Emergency Medical Services (EMS) Coordinator Andrew Tran of Orange County Fire Authority to obtain service calls received from facility for requested assistance to residents. EMS Coordinator stated that Orange County Fire Authority (OCFA) looked into the history of facility and stated that OCFA did not receive any calls for service in over a year.

LPA Tirre contacted Anaheim Fire and Rescue regarding service calls from facility requesting for assistance to residents. Anaheim Fire and Rescue Emergency Medical Services (EMS) Nurse Educator Jamie Jantzen stated that their department received 25 calls for fall lift assists for 2024 year.

On July 31, 2024 Facility Witness contacted Department and did not corroborate allegations stating they were “just rumors and inaccurate information”.

During visit on August 6, 2024 LPA did not observe any health and safety concerns while touring facility.

Based off information obtained this agency has investigated the complaint. Although the allegations Staff leave the residents unattended for an excessive amount of time and Staff are not providing adequate care and supervision may have happened or is valid , there is no preponderance of evidence to prove the alleged violation did or did not occur , therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Pellicer and a copy of this report was provided to facility.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC9099 (FAS) - (06/04)

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