Facility Evaluation Report

On 03/08/2024 at 11:30AM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 2/26/2024. LPA met with Director of Health Services(DHS) and explained the purpose of the visit.

The incident report received stated that Resident (R1) eloped from the south side exit door of the facility at 7:17PM on 02/24/24. Staff (DHS) reviewed security footage and confirmed R1 eloped at 7:17PM that night. Staff reset the exit door alarm at 7:19PM and did not immediately look for missing R1. Records review of R1's physician's report dated 06/24/22 indicated that R1 is not able to leave the facility unassisted. Incident report dated 02/26/24 showed that R1 was noted missing by staff at 7:30PM when caregiver went to look for R1 to assist him to bed. At 7:43PM, R1 was reportedly found by a concerned citizen who called the facility with the location of R1. Staff returned R1 safely back to the facility at 8PM on 02/24/24. DHS stated staff notified her of R1's elopement incident at 8:17PM on 02/24/24. LPA obtained a copy of the staff roster, resident roster, resident's (R1) physician's report and progress notes for the month of February 2024 during the visit.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. A copy of appeal rights and this report was provided to DHS.