Facility Evaluation Report

Licensing Program Analyst (LPA) Nakagawa arrived unannounced to conduct a case management visit regarding the self-reported incident of resident (R1) eloping from the facility on 06/16/2026. LPA met with Administrator Maria Burton to discuss.

The self-reported incident occurred on 06/16/2026, when resident (R1) left the facility between 8:40 AM (after med. tech. came and administered medications) and 10:00 AM (when the private caregiver arrived and found R1 was not in the room). Caregivers searched facility and nearby area. R1 was spotted by private caregiver walking a short distance away on Shasta Drive. Private caregiver picked R1 up and returned to facility. R1 was assessed and found to have no injuries.

LPA reviewed records which included the facility's incident report and R1's Physician's Report, which indicates R1 is unable to leave the facility unsupervised. (Deficiency cited).

Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and/or the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.

An immediate civil penalty is being issued in the amount of $500 per Health and Safety Code 1568.0822(C)(3) Absence of Supervision.