Facility Evaluation Report

At approximately 10:05 AM, Licensing Program Analyst (LPA) Nakagawa arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator, Fernando Valadez. The purpose of the visit was to follow up on a self-reported incident that was submitted to Community Care Licensing (CCL).

CCL received an incident report on 05/13/2025. The report stated that on 05/11/2025, Resident (R1), who has a diagnosis of dementia and is unable to leave facility unassisted, eloped from community. Staff became aware of R1's absence at 7:30 PM; Administrator, police and family were notified. At approximately 7:40 PM R1's family notified community that R1 had walked to his home and was safe. Administrator went to location of R1. R1 was not in need of medical attention so Administrator 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 .