Facility Evaluation Report

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management in response to the Unusual Incident Report (UIR) for resident (R1) submitted by the administrator.on 1/22/24. LPA met with Joseph Crisol, administrator, and informed the reason for visit.

LPA obtained and reviewed R1's LIC602 Physician's Report, LIC625 Appraisal/Needs and Services Plan, LIC601 Identification and Emergency Contact Information and conservatorship document.

UIR indicated the following: in the afternoon of 1/20/24, staff noticed R1 was not in his room and common areas. Staff took the company car and search for R1. The other staff filed a report to local law enforcement and notified the administrator. R1 was found by local law enforcement in Contra Costa County the following day, 1/21/24. Administrator picked-up and brought R1 back to the facility.

On this day, 1/25/24. LPA conducted inspection and interviews. LPA observed all entrance/exit doors without and R1's room's exit door leading to the side yard without auditory signals and LIC625 not updated to include on the care plan the AWOL behavior.

Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809D. Failure to submit proof of corrections by plan of correction due dates may result in civil penalties.

Deficiencies and plan and proof of corrections were discussed with the administrator.

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