Facility Evaluation Report

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced Case Management- Incident inspection visit. LPA Quiroz was granted entry by Staff 2 (S2) and met with Licensee/Administrator (L/AD) Helen Hafalia and discussed purpose of the inspection visit.

On 10/03/2022, Orange County Regional Office CCL received a special incident reporting indicating that on 9/27/22 Client #1 (C1) on or about 5:00pm, left facility unassisted and missed his evening and morning medications of 9/28/22 and returned back to facility on 9/28/22 on or about 8pm. It was also reported that on 9/29/2022, (C1) left facility on or about 4:00am, and Licensee/Administrator Helen Hafalia and S2 went to go look for (C1) and located (C1) at 7 Eleven store approximately 2.6 miles away from the facility. On both occasions, (L/AD) informed C1's Responsible Party (RP) and Orange County Regional Center (OCRC).

(L/AD) Hafalia indicated OCRC and C1s (RP) and (L/AD) Hafalia will be meeting on 10/5/22 at 3:00pm to discuss C1s recent elopement behaviors both within the same week. (L/AD) Hafalia indicated OCRC Service Coordinator indicated that a request for additional staff has been submitted and that OCRC is seeking extra funding to provide additional staff supervision for C1 due to increase elopement behavior while residing at this facility. C1 was admitted to facility on 8/25/2022.

C1 has a history of running/wandering away occurring at least once per month, but not every week. Individual Program Plan (IPP) dated 7/5/2022 page 8 of 11 indicates C1 "has a history of running away and being a recluse and that he has become better with this but still happens on occasion when he is extremely upset. He will leave the house and not return for a few days at a time."

On today's date, LPA Quiroz observed C1 arriving from work on or about 3:10pm. LPA Quiroz introduced self to C1, and interviewed C1 during today's visit . C1 appeared to look in good spirits and was dressed weather appropriate.