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, Blaine Lyons. 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 11/17/2025. The report stated that on 11/16/2025, Resident (R1), who has a diagnosis of dementia and is unable to leave facility unassisted, eloped from community at 8:31 AM, according to surveillance video. Staff immediately responded to R1’s security bracelet at the front door alarm. Staff were alerted to R1’s elopement at 8:31 AM and staff pursued R1, losing sight of R1 in the adjacent neighborhood. Administrator, police and family were notified. R1 was found safe at relative's house close to the facility. R1 was released to staff and returned to the facility. R1 was not in need of medical attention.

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 $1,000.00 was issued during today's visit for a repeat violation, Absence of Supervision.

Deficiency cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.