Facility Evaluation Report

On 2-24-23 at 12:00pm, Licensing Program Analyst (LPA) conducted a case management visit regarding 2 incidents which occurred on 1-28-23. LPA met with Administrator Susan Lo and explained the purpose of the visit. LPA interviewed Administrator and reviewed incident reports dated 1-30-23, and physician’s reports for resident1 (R1) and R2. LPA also reviewed resident sign in and sign out sheets dated 1-28-23, and facility’s missing person policy. Based on interview and record review, it was determined that on 1-28-23 R1 signed out of facility at 4:23pm; R2 signed out of facility at 2:15pm on 1-28-23.

Based on incident report and interview, R1 and R2 did not return by curfew times of 8:00pm on 1-28-23. Staff search local area but were unsuccessful in locating R1. Facility notified appropriate parties including licensing department, responsible persons and local law enforcement per regulatory time frames and internal company policy. Facility staff learned on 1-30-23 that R1 had been in policy custody since 1-28-23. R2 was not located per local law enforcement notification updated on 2-23-23, and bed hold was initiated by R2’s conservator. R1 and R2 no longer reside at facility.

LPA review of sign in and out forms dated 1-28-23 revealed R1 and R2 signed out and included intended destination alerting staff of R1 and R2’s general whereabouts.

Based on today’s case management no citations are issued. An exit interview was conducted with Susan Lo and a copy of this report was left with Susan.