Facility Evaluation Report

On 8/8/2023, Licensing Program Analyst (LPS) Grace Donato conducted an unannounced case management visit. LPA met with Licensee, Susan Tilma. LPA explained the pruspose of the visit.

LPA received information regarding concerns about male caregiver (S1) “ripping clothes” of a female resident (R1). Another report regarding a resident (R2) eloping on 6/27/23.

On the concern about a S1 “ripping clothes” of R1, based on interviews, it cannot be confirmed that said incident happened due to R1 passing. R1 has been on hospice and has dementia.

With regards to R2 eloping, no record of the incident was reported to the facility. Based on interviews, Licensee mentioned that they weren't able to report the incident to CCLD. R2 likes walking around the facility. R2 was able to exit on one of the gates. On the day mentioned, R2 was able to go out unsupervised. Based on record reviews, resident has dementia and should not be able to leave the facility without supervision.

Deficiencies are cited today as the facility did not ensure the elopement incident was reported on a timely manner to CCLD. Also, the facility staff wasn't able to supervise the R2 while going around the facility leading him to leave unaccompanied/unsupervised.

Deficiencies are cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. Report was discussed and a copy of this report and the Appeal Rights are provided.