Facility Evaluation Report

At approximately 1:30 PM, Licensing Program Analyst (LPA) Hansen arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator, John Beltz. 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 05/07/2025. The report stated that on 05/03/2025, Resident (R1), who has a diagnosis of dementia and is unable to leave facility unassisted, eloped from community at approximately 4:30 PM, when R1 was last seen participating in memory care activity, later finding, exited via front door. At approximately 4:50 PM, Activity Director observed R1 sitting on a bus stop bench down the street from community, where Activity Directory escorted R1 back to community; PCP and family were notified. R1 was assessed at facility, no injuries sustained.

Per R1’s Physician’s Report (LIC602) R1 is diagnosed with dementia and is unable to leave the facility unassisted. (Deficiency cited)

Civil Penalty for $500.00 was issued during today's visit for Zero Tolerance, Absence of Supervision.

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