Facility Evaluation Report

Licensing Program Analyst (LPA) Angela Panushkina conducted a Case Management - Incident visit. LPA met with Administrator and explained the reason for the visit.

On 05/26/26, the Department received a self-reported incident report stating that Resident #1 (R1) had left the facility on 05/24/26 and did not return. The incident was reported to police (copy of the the report is also obtained).

During today's visit, LPA conducted a physical plant walk through, at approximately 12:35pm, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA did not observe any immediate health and safety issues during the visit.

LPA conducted interview with the Administrator and attempted to contact R1's Power of Attorney. LPA also obtained copies of R1's facility records.

Upon review of the physician's report dated 04/22/2026, the report states that R1 has dementia and is not able to leave the facility unassisted. Interview with the Administrator revealed that R1 lived at the above facility since 04/04/26 and was very happy with the place. The Administrator denied seeing changes in R1's behavior. Interview with S1 revealed that on a day of an incident, at approximately 8:00pm, R1 was smoking outside (backyard) and asked S1 to get pull-ups, so that R1 can change and get ready for sleep. LPA was informed that around 8:07pm S1 brought the pull-ups and did not observe R1 sitting outside. S1 looked around and went outside (to the front) and still did not observe R1. S1 immediately contacted the Administrator and the law enforcement regarding the incident. R1 is still missing and Administrator currently does not have any updated information on R1's whereabouts. LPA will conduct a follow up visit regarding this incident.

Exit interview conducted and copy of this report signed and issued.