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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005730
Report Date: 10/21/2025
Date Signed: 10/21/2025 04:53:01 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/21/2025 04:53 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MERIDIAN AT ANAHEIM HILLS, THEFACILITY NUMBER:
306005730
ADMINISTRATOR/
DIRECTOR:		PELLICER, RAYFACILITY TYPE:
740
ADDRESS:525 S ANAHEIM HILLS ROADTELEPHONE:
(714) 974-2226
CITY:ANAHEIMSTATE: CAZIP CODE:
92807
CAPACITY: 120CENSUS: 200DATE:
10/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Ray Pellicer, Executive Director/AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On October 21, 2025, Licensing Program Analysts (LPASs) Eboni Bentley and Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year Annual evaluation. LPAs were greeted and granted entry by Executive Director/Administrator (AD), Ray Pellicer, stated the purpose of the visit and were granted entry. The certificate for Administrator, Ray Pellicer is currently valid expiring on November 7, 2026.

The facility has a resident census of seventy three. A sample of eleven resident records and five staff records were reviewed during the visit. Background clearance and association to the facility was verified for staff members on the roster.

LPAs toured the physical plant with Resident Services Director Analyn Samson and the following was observed: The facility is three multi-story buildings arranged around a central courtyard. LPAs conducted a tour of the interior and exterior of the physical plant. Eleven resident units in Assisted Living and Memory Care were inspected and found to be clean, sanitary, and in good repair. All units had the required furnishings, bedrooms and bathrooms contained adequate storage space, were clean, and kept free of obstructions. Bathrooms were observed with non-skid mats and grab bars on the inside of the shower. The hot water temperature measured between the ranges of 105.0 and 114.0 degrees Fahrenheit in eleven resident bathrooms and common area bathrooms. All common areas were inspected including the kitchen, dining, activity rooms, and courtyards. LPAs observed sufficient emergency food and water in the kitchen and storage. The outdoor passageway is free of obstruction.

CONTINUE TO LIC809-C.....

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MERIDIAN AT ANAHEIM HILLS, THE
FACILITY NUMBER: 306005730
VISIT DATE: 10/21/2025
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The Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the correct size. Emergency disaster drills was last conducted on July 7, 2025. First aid kit is maintained and contains all the necessary elements. Smoke and carbon monoxide alarms were lasted inspections on May 13, 2025, per the inspection log. The facility has fire extinguishers that were charged throughout the facility, all last serviced on September 3, 2025. Liability Insurance is effective March 1, 2025 through March 1, 2026.

Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Cleaning supplies and sharp items were inaccessible to residents in care. LPAs reviewed resident medications and found one resident (R1) with medication errors, as four routine medications were not given as prescribed on October 12, 2025.

Based on the observations made during today's visit, a Type B deficiency is being cited per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Executive Director/Administrator, Ray Pellicer. Resident Services Director Analyn Samson, and Memory Care Director Ira Lustina, and a copy of this report, LIC809-D, LIC811, Technical Violation, and appeal rights were provided to Executive Director/Administrator, Ray Pellicer.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/21/2025 04:53 PM - It Cannot Be Edited


Created By: Eboni Bentley On 10/21/2025 at 03:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MERIDIAN AT ANAHEIM HILLS, THE
FACILITY NUMBER: 306005730

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/29/2025
Section Cited
CCR
87465(c)(2)

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87465(C)(2) Once ordered by the physician the medication is given according to the physician's directions.

This is evidence by:
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Executive Director stated they will retrain all medication staff and provide proof of training, content, attendees, and date of training to CCLD by POC due date.
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Based on observations and record reviews, four routine medications were not given as prescribed for R1 on October 12, 2025, which poses a potential health and safety risk to persons in care.
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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.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Eboni Bentley
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2025


LIC809 (FAS) - (06/04)
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