Complaint Investigation Report

Interviews with staff revealed that residents are taxied in the van if they are scheduled for a doctor's appointment or if they had signed up for an activity that took place off property. Staff 1 (S1) confirmed that R1 was not signed up for any activities that day and did not have a doctor's appointment scheduled. Staff 2 (S2) stated that they were present when R1 was found near the van and reported that R1 had not been scheduled for a doctor's visit that day and instead had tried to elope from the facility through the stairwell leading to the parking garage.

Interviews with Outside Source 1 (OS1) revealed that R1 was found near the van in the parking garage on the facility grounds. OS1 was able to stay with R1 until they could ask S2 to come and retrieve R1 and return them to the building. OS1 did not report seeing R1 inside the van at the time of discovery.

Records review confirmed that R1 has a history of Alzheimer's disease. An activities calendar for November showed a scheduled outing for November 18th, 2025 at 1:30pm titled, "Oceanside Coffee Date." On the Sign up sheet for the outing R1's name is absent which corroborates staff interviews.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Mike McCoy, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.