Facility Evaluation Report

On 06/05/2025 at 12:35 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident that occured on 06/03/2025. Administrator self-reported the incident on 06/04/2025. LPA met with Administrator (ADM), Gina Velayo, and explained the purpose of the visit.

LPA received an incident report from the facility that indicated Resident 1 (R1) went AWOL by exiting through a window in another resident's room. The facility was doing a headcount after dinner and when they noticed R1 was gone. R1 was found down the street and was escorted by staff to come back to the facility.

During the visit, LPA reviewed R1's Physician Report dated 03/09/2023 that indicated that R1 has a diagnosis of Dementia and is not able to leave the facility unassisted. LPA toured the facility and observed the window auditory device where R1 left from was functioning loud and clear. However, based on interview conducted, ADM stated that she does not know whether the alarm was on at that time because staff would sometimes turn it off to open the windows when assisting residents. LPA also observed in R1's room the auditory signal was displaced on the window, the windowsill was broken, and rust on the closet panel.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiency within a 12-month period may result in civil penalty.

Exit interview conducted. Appeal Rights and a copy of this report provided.