Complaint Investigation Report

392700306-6-24-2022-27-AS-KHOS-CFUHNK-20220629062051

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

05/16/2022 and conducted by Evaluator Bruce Jacobs

COMPLAINT CONTROL NUMBER: 27-AS-20220516162447

Resident eloped from the facility without staff knowledge

Staff did not inform authorized representative of resident's

Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility and met with Administrator Gurpreet Rai to deliver investigation findings on the above allegations. This investigation consisted of site inspections to the facility to conduct interviews with the facility administrator, staff and other witnesses. Records were reviewed and copies of pertinent documents were obtained for the complaint file.

This investigation concluded that on the evening of May 15, 2022, a resident (R-1) left the facility without staff's knowledge. The resident has a diagnosis of dementia and was not authorized by his physician to leave the care home without assistance. Care home staff did not notice the resident was missing until the following day when they were notified by a local hospital. In addition, the facility did not notify the responsible party as required.

As a result of this investigation, LPA finds the allegations to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies are cited on 9099-D, per Title 22 Regulations, Division 6.

Exit interview conducted and report provided. Appeals rights printed.