Facility Evaluation Report

Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced at facility to conduct a Case Management Incident Visit and met with Administrator, Grant Haywood. The purpose of the visit was to follow up on self-reported incident that was submitted to Community Care Licensing (CCL).

CCL received an incident report on 6/22/2026. The report stated that on 6/15/2026 at approximately 10:30pm a door alarm was activated and Resident (R1), who has a diagnosis of dementia and is unable to leave facility unassisted, eloped from community. Staff responded to alarm but did not conduct exterior search or head count of residents. At approximately 12:20 AM, R1's POA contacted facility indicating R1 was with Law Enforcement who had contacted POA after R1 had been going to homes adjacent to community for approximately 2 hours and one neighbor had contacted Law Enforcement. R1 was brought back inside community by Law Enforcement after being located in parking lot. R1 was assessed at facility, no injuries sustained. During today's visit, it was revealed to LPA that R1 had exited by east side door next to apartment right after cross over when PM shift informs NOC shift of days current events.

Per R1’s Physician’s Report (LIC602) 1/13/2026, R1 is diagnosed with dementia and is unable to leave the facility unassisted. (Deficiency cited). Some elopement training's have been conducted & disciplinary action taken for 2 caregivers.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided