Facility Evaluation Report

On 9/21 23 at approximately Licensing Program Analysts (LPA Maja Jensen and Kimberly Viarella arrived unannounced to conduct a case management in relation to an incident report received by the Department on 9/17/23. LPA Jensen and Viarella met with Health and Wellness Director Terri Ford and explained the purpose of today's visit.

The incident report received stated that Resident 1 (R1) left the facility unassisted and without staffs knowledge on 9/16/23. LPA Jensen conducted an interview with the Health and Wellness Director and was advised that in the morning on 9/16/23 staff did rounds at approximately 7am and R1 was observed in her room. At 7:45am staff went to R1's room and could not locate her. Staff reviewed video footage for the main entrance of the facility and saw R1 leave through the front door at 7:31am. At approximately 8:15am the resident was located by a family member and brought back to the facility. LPA Jensen was also advised that R1 had a previous elopement approximately 2 months prior to the incident of 9/16/23. On 9/17/23 R1 was moved from the assisted living section of the facility to the memory care unit.

LPA Jensen reviewed the LIC 624 (Unusual Incident/Injury Report) and the LIC 602 (Physician's report). The LIC 602 indicates that the resident cannot leave the facility unassisted.

Citations are being issued pursuant to the California Code of Regulations (CCR) Title 22, Division 6.

An exit interview was conducted and a copy of this report, an LIC 811 and appeal rights were provided.