Facility Evaluation Report

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management visit in response to the 3 Unusual Incident Reports submitted by the facility and received by LPA in April 2025 for resident (R1). UIRs indicated that on April 13, 2025, local police department informed the staff that resident (R1) was taken in custody and the details surrounding the incident remains confidential. Staff contacted the police department and was informed that R1 was released the same day. R1 did not return to the facility and staff filed a missing person report. The UIRs indicated that R1 was taken into custody again on April 15, 2025.

On this day, May 21, 2025, LPA met with staff Sameer Aziz and Elisa Chente. LPA later met with Alanna Spencer. LPA conducted interviews and obtained copy of R1's LIC602 Physician's Report and facility notes. LIC602 showed R1 can leave the facility unassisted. LPA also learned that on April 22, 2025, R1 was taken into custody again; however, no UIR submitted nor received by LPA.

Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. A $250.00 civil penalty is assessed for deficiency section # 80061(b)(E) for repeat violation within 12 month period. Failure to submit proof of correction (POC) by plan of correction due date may result in additional civil penalty.

Deficiency and plan and proof of correction were discussed with ADM. .

Exit interview conducted. Appeal Rights, LIC421FC Civil Penalty Assessment, LIC9098 Proof of Correction form, and copy of this report provided.