Facility Evaluation Report

On 05/02/25, Licensing Program Analyst (LPA) Pang Lee conducted an unannounced visit to the facility to follow up on an incident report received by the Department. Upon arrival, LPA Lee was greeted by care staff member Mason Moyrong and explained the purpose of the visit. Care staff contacted the Facility Designated Administrator (FDA), Mitzi Caguiat, to inform her of LPA's presence. A brief interview was conducted via telephone with administrator Caguiat. At the time of the visit, the census was 6 residents with 1 facility staff present.

The Department received an LIC 624 incident report on 02/24/25, concerning an event that occurred on 02/17/25, involving Resident 1 (R1). According to the report, R1 left the facility for a walk around 3:00 PM. At approximately 6:00 PM, law enforcement officers arrived at the facility and informed staff that a male victim had been found at Sims Park with a gunshot wound and needed to be identified. It was later confirmed that the victim was R1.

According to the incident report, R1 was conscious at the scene and was transported to UC Davis Medical Center for medical treatment. During an interview, Administrator Caguiat stated that R1's case workers were notified of the incident. In an interview with administrator Caguiat she stated that the case workers informed her that R1 declined to authorize a release of information; therefore, the resident's family was not informed of the incident. A review of R1’s LIC 602 Physician’s Report indicates that R1 is permitted to leave the facility unassisted. R1 is able to go to the store with minimal communication based on their needs and service. Moreover, based on record review R1 was sign out of the facility on 02/17/25 at 3:00 to go to the park.