Incident investigation·February 28, 2025

On this day, 2/28/25, at 11:05 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced in response to the Unusual Incident Report (UIR) for resident (R1) submitted by the facility and received by LPA on 2/27/25. LPA was granted entry by staff, Norma Gano. LPA called and spoke over the phone with Justino Balintona, licensee-administrator, and informed the reason for visit. Licensee arrived at around 11:35 am. UIR indicated that on 2/27/25, the licensee noticed R1 was not in his room. The whole house was searched and the other resident's room's door leading to the outside was ajar and fence gate open. The immediate surroundings were searched and police assistance requested. R1 was located along the road 3 blocks from the facility with abrasion on the right forehead. R1 was brought to the hospital. LPA checked and observed all exit doors have auditory signals but unarmed. LPA also observed the following: staff's (S1 and S2) medications in the living room; disinfectant spray in the dining area. LPA met and interviewed R1. LPA observed bandage in R1's forehead and bruise in the left palm. LPA also interviewed the staff. LPA reviewed R1's file and obtained copy of LIC602A Physician's Report and LIC601 Identification and Emergency Contact Information. LIC602A showed R1 has major neuro cognitive disease and will be at risk if R1 leaves unassisted. .....continued on 809C Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section 87705(d) and $250.00 for repeat violation of section 87309(a) within 12 month period and will continue for $100.00/day for each if not corrected. Deficiencies and plan and proof of corrections were discussed with the licensee Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, LIC421IM and LIC421FC Civil Penalty Assessments, and copy of this report provided.