Follow-up·May 26, 2022

On 05/26/2022, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit regarding self-reporting an AWOL incident in the memory care unit. LPA met with Bernadette Bender Memory Care Director and explained to the purpose of the visit. The Director stated that 4 staff worked on the same PM shift on 5/23/22. The subject resident (R1) was noticed missing in the memory care at around 4:45pm, none of the staff heard the door alarm when R1 eloped, and how R1 eloped was unknown, 911 call was made. The Director confirmed that R1 was able to exit the facility and was found on the street after 2 hours of missing, R1 didn't return to facility after being found. Discharge paperwork was completed by her daughter the next day which was 5/24/22. LPA inspected the memory care unit, there are 5 exit doors around and were observed to be locked during visit. LPA obtained and reviewed R1's physician's report, needs and services plan, admission orders, and staff schedule. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proofs of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties . Exit interview conducted with the Memory Care Director. Appeal Rights and a copy of this report provided.