Facility Evaluation Report

Licensing Program Analyst (LPA) Hansen conducted an unannounced case management and met with Administrator Donald Stamets. The purpose of this case management inspection is to follow up on a self-reported incident report submitted to Community Care Licensing (CCL).

CCL received a self-report incident report form on 3/28/2023 reporting on 3/17/2023 at approximately 9pm resident (R1) had eloped from community. Facility staff and law enforcement conducted search and located R1. Law enforcement returned R1 to community approximately 30 minutes later. LPA obtained records indicating R1 has diagnosis of dementia and is not to leave unassisted. LPA is issuing a citation today for R1 eloping from facility without staff knowledge on 3/17/2023. Administrator has informed R1's spouse has moved into facility relieving R1 of exit seeking at this time.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided