Facility Evaluation Report

On 7-21-22 at 2:50pm, Licensing Program Analysts (LPAs) Michael Bilger and Renee Campbell arrived unannounced to conduct a case management visit regarding an incident reported to licensing department on 6-17-22. LPAs met with assistant administrator Ildefonso Letran and explained the purpose of the visit. Ildefonso notified Administrator Maricor Camero to make aware of LPAs visit. LPAs reviewed incident report for resident1 (R1) dated 6-17-22 with assistant administrator as well as an “addendum” to the incident report dated 6-18-22 and received by licensing department 6-20-22. Additionally, LPAs reviewed Physician’s Report for R1. LPAs also interviewed assistant administrator. The addendum reviewed also included a 30-day notice of eviction to R1 due to multiple elopement attempts and other behaviors with intended move out date of 7-18-22.

Upon review of 30-day notice, it was determined that notice met regulatory requirements and sent to R1s responsible party on 6-18-22, along with a copy sent to licensing department on 6-20-22. R1 currently continues to reside in facility at this time. LPAs verified through email and fax communication between assistant administrator and R1’s service coordinator that service coordinator was sent the 30-day notice on 6-18-22 and acknowledged.

Incident report dated 6-17-22 stated R1 exited facility on 6-16-22 at approximately 9:20am. LPAs interviewed assistant administrator and reviewed sign in and sign out sheet which indicated R1 did not sign out. LPAs also reviewed Physician’s report for R1 which indicates R1 is able to leave facility unassisted. The incident report reviewed stated “Staff…followed him along the street but couldn’t see him anymore.” Incident report also stated “Two staff were also looking for him but unsuccessful to find him.” Based on record review and interview, it was determined staff was unaware of R1s whereabouts. The addendum to incident report dated 6-18-22 states R1 “was found on the street by Police on June 18, 2022 and was dropped off at Melmar’s Home at about 8:00pm.”