Incident investigation·July 21, 2023

On 7/21/2023 at 10:05am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an AWOL incident report received for Resident 1(R1) on 6/26/2023. LPA met with House Manager, Jezrael Pascual, explained the purpose of the visit. LPA spoke with Administrator, Victoria Puruganan , via telephone and was give approval for house manager to sign documents. Upon arrival LPA observed front window broken with red tap holding window. Incident report stated R1 AWOL'd on 06/23/2023. Staff 2 (S2) stated that Resident 1 (R1) normally takes a nap around 2pm, however staff went to check on R1 and noticed he was not in his room or outside. S2 stated staff checked to both corners of the street. S2 then called Administrator, 9-1-1, and hospitals. Oakland Police Department notified facility later that night he was found in Pleasanton. R1 was discharged back to the facility on 6/24/2023. S2 stated Staff 3, 4, and 5 (S3, S4, and S5) were also present during the incident. Review of R1's 602 dated 4/2/2023 indicate R1 is not able to go into the community without supervision. S2 stated during interview that R1 AWOL'd again on 7/17/2023 and was found in Fremont. R1 was discharged on 7/18/2023. Incident report was submitted to CCLD on 7/18/2023. Continued LIC809. Continued from LIC809. During R1's file review LPA observed that R1 has a restricted health condition, but does not have a skilled professional caring for the restricted health condition. LPA collected the client roster. LPA requested the following documents to be submitted to CCLD by 7/28/2023: personnel record (LIC500), physician's report (LIC602) appraisal needs and services plan, and admission agreement. LPA observed office was different than on facility sketch. LPA toured facility with house manager and observed. LPA observed that part of the activity/entertainment room was turned into a bedroom and R2 was placed in that room. Bedroom #9 was split into two (2) rooms. The area called the solarium is blocked. During reviewed of R2's file, LPA observed the physician's report was last conducted 9/24/2018, appraisal needs and services 9/25/2019. LPA observed the following deficiencies: R1 does not have a skilled professional to caring for his restricted health condition. R2 does not have a current physician report or appraisal needs and services plan. The area called the solarium is blocked with a couch, 2 refrigerators, 13 5-gallon water bottles, a small piano, clothing, and 3 walkers. The facility have conducted alterations and did not obtain a permit or notify CCLD Continued on LIC809C. Continued from LIC809C. The following deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (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. Appeal Rights and a copy of this report provided.