Facility Evaluation Report

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct case management as a follow-up on the Unusual Incident Report (UIR) received by the Department. UIR indicated that on October 19, 2022, staff checked on resident (R1) in room and common areas around 9:10 am, and unable to locate R1. Staff immediately activated code silver. Executive Director checked the camera monitor and saw R1 leaving around 9:00 am. Staff followed the route R1 headed, and found R1. R1 was not on apparent distress.

LPA requested for copies of LIC602A Physician's Report which revealed R1 has dementia and wandering and sundowning behaviors, and can not leave the facility unassisted.

On this day, LPA observed the front door entrance's auditory device not working.

Deficiendies cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections (POCs) by plan of correction due dates, and any repeat violations within 12 month period may result in civil penalties.

Deficiency and plan and proof of correction were discussed with Rosana Frias.

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