Facility Evaluation Report

Licensing Program Analysts (LPAs) Kimberly Lyman and Kevin Saborit-Guasch made an unannounced case management visit to follow up on an incident report submitted to Community Care Licensing (CCL) on 11/09/2021. LPAs met with Care Coordinator Alexis Jones and explained the reason for the visit.

Incident report dated 11/09/2021 indicated that at approximately 1:30pm on 11/03/2021 Resident 1 (R1) stated he was leaving to the 99 cent store. At around 5:30pm caregivers notified he was not present within the facility. Police was called and a missing person report was filed at approximately 7:30pm.

LPAs reviewed R1 medical file and physician's report, dated 08/25/2021. Mental Condition items indicate that R1 is both ambulatory and able to leave the facility unassisted. During a physical tour of the facility, R1 was observed to be relaxing in their own bedroom.

Exit interview conducted and a copy of this report was left at the facility.