Facility Evaluation Report

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit to the facility regarding an Unusual Incident Report (UIR) received by the Department on April 22, 2026. Upon arrival, LPA was greeted and granted entry into the facility by Case Manager April Pena. LPA explained the purpose of the visit. The UIR stated that Resident 1 (R1) left the facility unassisted and was returned to the facility by the police department. During today’s visit, LPA discussed the incident with Case Manager and obtained additional information regarding the circumstances surrounding the incident. LPA also reviewed relevant facility records, including R1’s Physician’s Report, LIC 602 form. Records review noted that R1 cannot leave the facility unassisted and that R1 has mild cognitive impairment. Based on the information obtained during today’s visit, the facility failed to provide adequate care and supervision to R1 when R1 left the facility unassisted and was returned by the police department. One deficiency is being cited pursuant to Title 22, California Code of Regulations.An exit interview was conducted with Case Manager, Pena, and a copy of this report, along with appeal rights, was provided to the facility .