Facility Evaluation Report

Licensing Program Analyst(s) Victoria Brown and Sommer Hayes arrived unannounced to conduct a Case Management visit on 3/10/25 at 3p. LPAs met with 2 caregivers who contacted the Administrator regarding the purpose of todays visit.

Community Care Licensing (CCL) received an Incident report indicating that resident # 1 (R1) was found to be involved in an unsafe wander situation. R1 was not located by staff during a room check.

An Incident report was submitted to CCL indicating at approximately 6:30p on 3/5/25 R1 was discovered to not be in the room. Law enforcement was contacted who located R1 at approximately 6:50p.

LPAs observed that the alarm on the slide door to the backyard was not operable during this visit.

The Investigation revealed that R1 could not leave the facility unassisted as stated in the Physician Report (LIC602) dated 1/6/25.

Based on LIC602 and the LIC624 that was submitted the facility will be cited during this visit as R1 left facility without supervision.

Per California Code of Regulations (CCRs) - Title 22, Div.6, Ch. 6, deficiencies are being cited on the attached 809D during this visit. If any deficiencies are not corrected by the noted due dates; civil penalties may be assessed. A copy of their rights was provided (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, a copy of this report was provided.