Facility Evaluation Report

Licensing Program Analyst (LPA) Jerome Haley conducted a case management visit regarding information discovered during the investigation into complaint control # 22-AS-20250723144514

During the complaint investigation mentioned above, LPA Haley received confirmation that, the facility did not report an elopement incident involving Resident 1 (R1). S1 reported the incident to an Assisted Living Waiver (ALW) personnel, but did not inform the department. S1 forwarded LPA Haley a copy of the incident report that was sent during the visit.

LPA Haley checked the department’s SharePoint data base where incident reports are stored and there was no incident report for R1.

As a result of today’s Case Management visit, a violation will be cited per California Code of Regulations Title 22.

An exit interview was conducted and a copy of this report, and appeal rights were provided.