Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai arrived unannounced to conduct a case management visit to follow up on Incident Report for 11/25/2024 where resident R6 left the facility without the knowledge of the staff. LPA Rai met with Designated Administrator/ House Manager (HM) Filimon Zewde and stated the purpose of today's visit.

On 11/25/2024 at 6:00pm, R6 returned the facility after visiting family. At around 10:00pm, staff observed R6 going to the room. At approximately 1:30am, staff did their routine rounds of the facility and observed R6 was not at the facility. Facility staff drove around the neighborhood and did not find R6. At approximately 1:50am, R6 returned to the facility by himself/herself. R6 notified staff that he/she went to the store to buy soda and left the facility through the back door through the back yard exit.

During today's visit, LPA Rai interviewed Designated Administrator/ House Manager (HM) Filimon Zewde regarding the Incident Report. HM stated they have placed door alarms on the exit doors leading out of the facility to the main street. HM stated R6's elopement behaviors are initiated when R6 returns from visiting family. HM stated they routinely will take R6 to the store when R6 returns back to the facility after visiting family to ensure R6 purchases items and does not display the elopement behavior to go out to purchase the items himself/herself. HM stated they will collaborate with San Andreas Regional Center (SARC) to provide R6 1:1 staff supervision when R6 returns back to the facility after visiting family. HM stated there is 1 awake staff at night during the hours of 10pm to 6am.

Based on review of LIC 500 dated 12/1/2024, LPA Rai reviewed 1 staff is scheduled to work 8pm to 8am Monday through Friday and 1 staff is scheduled to work 8pm to 8am Saturday and Sunday.