Facility Evaluation Report

At approximately 9:20 AM, Licensing Program Analyst (LPA) Nakagawa arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator, Miriam Faris. 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 04/23/2025. The report stated that on 04/20/2025, Resident (R1), who has a diagnosis of dementia and is unable to leave facility unassisted, eloped from community at 4:26 PM, according to surveillance video. Staff failed to respond to R1’s security bracelet and the side door alarms. Staff became aware of R1’s elopement at 6:45 PM; Administrator, police and family were notified. Davis Police notified community that resident was found safe off premises 2.4 miles away inside a store. Administrator went to location of R1 and met with police. R1 was not in need of medical attention and released to Administrator, who transported R1 back to community.

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.

See LIC809-D for Deficiency. Exit interview conducted with Administrator and a copy of this report along with LIC811 (Confidential Names) was provided .