Facility Evaluation Report

On 1-27-22 at 3:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit for an incident which occurred on 1-7-22. LPA met with Administrator Adetayo Kokumo and explained the purpose of the visit. COVID-19 screening questions performed prior to entry. LPA reviewed incident report for Resident1 (R1) dated 1-7-22 and interviewed Administrator. LPA also requested copy of Physician report and pre-admission appraisal for R1 Based on interview, it was determined that R1 exited facility on 1-7-22 at approximately 6:30am and was found by police 30 minutes later, and brought back to facility.

Review of R1’s physician report reveals R1 is able to leave facility unassisted, however, a diagnosis of dementia exists. It was further determined that a pre-admission appraisal was not completed prior to R1’s admission to facility.

As a result of today’s visit, deficiencies are cited under Title 22, Division 6, Chapter 8. An exit interview was conducted with Adetayo Kokumo and a copy of this report was left with Adetayo. Appeal Rights provided.