Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced case management visit during a complaint investigation visit. LPA met with Erin Mahoney and explained the reason for the visit.

On 10/19/23 LPA Flores delivered findings for a complaint #28-AS-20230328095738. During the investigation the following deficiencies were noted:

87211 Reporting Requirements: On 3/24/23, a resident was found on the corner of Lake and Villa St., by facility's staff who was going home after her shift, and brought the resident back to the facility. Resident #1(R1) was a memory care unit resident, who left the facility unattended. Community Care Licensing did not received an unusual incident report regarding the incident. A copy of incident report or transmission sheet was not provided during the visits conducted of 4/3/23 or 10/19/23. Per regulations incidents are to be reported to the department within 7 days of occurrence.

87705 Care of Persons with Dementia: During document review of the complaint investigation, LPA reviewed physician's report for R1 dates 8/17/21. A copy of transmission sheet for a request of physician's report made to the primary physician was provided dated 3/23/23. Per regulation any dementia resident is to obtain an annual medical assessment. Needs and care plan printed on 10/19/23 notes none for special needs, none for wandering and elopement. R1 had left the facility unattended and per interviews conducted will attempt to exit the memory care unit and no plan was developed to address the situation.

Deficiencies are noted on LIC 809D per Title 22 Regulations.

Exit interview was conducted with Erin Mahoney and a copy of this report, LIC 809D, and appeal rights was provided.