Complaint Investigation Report

392700225-11-17-2022-27-AS-KHOS-CLWKCA-20221208064649

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 2525 NATOMAS PARK DR. STE.270

This is an official report of an unannounced visit/investigation of a complaint received in our office on

11/10/2022 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20221110163839

Resident eloped over night due to lack of supervision

On 11-17-22 at 2:49pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate the allegation noted above. LPA was greeted by staff1 (S1) and spoke with Acting Administrator (S2). LPA also spoke with Administrator Mothanna Saleh via phone and explained the purpose of the visit. LPA interviewed Administrator, acting administrator and S1. LPA also reviewed physician's report for R1. Additionally, LPA reviewed emergency response report for R1. Based on interviews and record reviews, it was determined that R1 eloped from facility on 11-9-22 and facility staff was unable to locate R1 between approximately 6:00am and 7:00am. It was further revealed that facility staff was unaware of R1's whereabouts during this time period until staff called 9-1-1 and learned of R1's admission to local hospital. Based on interviews and record reviews, it is determined that R1 was without staff supervision due to an absence without leave (AWOL) episode. As a result, this allegation is SUBSTANTIATED. Citation is issued today under Title 22, Health and Safety Code, Chapter 3.2 and noted on LIC 9099D. An immediate civil penalty of $500 is issued in addition to citation. An exit interview was conducted with S1 and a copy of this report was left with S1. Appeal rights provided.