Facility Evaluation Report

Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an investigation into a self reported incident report received by Community Care Licensing (CCL) on 06/21/2023 regarding an incident that occurred on 06/18/2023. LPA met with Kyle Ruth-Islas, Administrator .

Based on incident report of 6/21/2023, resident (R1) left the facility unassisted and after search of facility ground and surrounding areas R1 was found across the street approximately 30 minutes later. No injuries noted. R1 then walked back with staff. R1’s Physician's report dated 1/3/2023 indicates R1 cannot be in the community without assistance from the staff. 24 hr private caregiver has been put in place to monitor. Facility reported to physician, responsible party and Community Care Licensing.

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..