Facility Evaluation Report

At approximately 11:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a case management visit in regards to an Unusual Incident report submitted by the facility. LPA met with Health Services Director Bryzanne Backman and reviewed records. The report stated Resident, R1, was found to be absent from their room during a room check at approximately 3:15AM. A community wide search was conducted and local law enforcement was notified. R1 returned to the facility on their own at approximately 4:00AM. Based on a review of records, R1 was an elopement risk since admission and had been on hourly checks since 09/23/2025, when they last eloped. LPA inspected exit doors throughout the facility. On the floor where R1 resided. Both exit door alarms were not operational. On the main floor, only 1 of 3 exit doors had an alarm installed and operational. On the first floor, 1 of 2 was turned off, but both operational. LPA requested the facility formulate a plan to ensure auditory staff alert devices are installed on all exit doors and periodic testing to ensure of their status.

An immediate civil penalty is being issued in the amount of $500 per Health and Safety Code 1568.0822(C)(3) Absence of Supervision.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with Bryzanne Backman and Appeal rights were given.