Facility Evaluation Report

On 6/23/2022 at 8:40AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management inspection in regards to incident report received on 6/9/2022. LPA met with Administrator, Gabriele Sibonga.

Incident report dated 6/9/2022 revealed that C1 left the facility on 6/8/2022 at around 9:30AM. S2 saw C1 walking and followed C1, but lost C1 around a corner. Staff tried to look for C1, but was unsuccessful. Staff called police for assistance. C1 was found by police about 30 minutes later.

Interview with S1 revealed that C1 has a history of AWOL. S2 stated that C1 walked fast and unable to find C1. S2 called police after unsuccessful in finding C1. S2 gave police facility's contact information. Less than an hour later, C1 was found by police. S1 stated C1 had a doctor's appointment on 6/21/2022 and medications were changed. C1's case manager is aware of the situation and will approve C1 to have 1:1 care and supervision.

During record review, LPA observed that physician's report dated 3/17/2022 stated that C1 cannot leave the facility unassisted. C1's IPP (Individual Program Plan) did not indicate that C1 required 1:1 care and supervision.

The deficiency was observed (see LIC 809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalty.

Exit interview conducted. A copy of this report and appeal rights provided.