Facility Evaluation Report

On 06/06/2025 at 9:15 AM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident that occured on 05/31/2025. Administrator self-reported the incident on 06/01/2025. LPA met with Administrator (ADM), Divine Fernandez, and explained the purpose of the visit.

LPA received an incident report from the facility that indicated Resident 1 (R1) went AWOL. The facility staff was informed by R1's sister that the resident was seen outside of the facility. R1 was found by the police and escorted to the hospital for post fall. R1 returned to the facility later on that day.

During the visit, LPA reviewed R1's Physician's Report dated 08/19/2024 that showed that R1 has a diagnosis of dementia and is unable to leave the facility unassisted. Interviews with ADM and Staff 1 (S1) indicated that residents with dementia has two bracelets such as a GPS tracker and one that will alarm when a resident is in close proximity of the exit doors. The GPS tracker revealed that R1 was still at the facility during that time. However, staff discovered later on that R1 took their GPS tracker off and placed it in the dining hall. S1 stated that they contacted 911 to follow their facility protocol for elopement when they were unable to locate R1. LPA attempted to interview R1, however, R1 does not recall the incident.

The following deficiency was 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.