Incident investigation·August 17, 2023

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management in response to missing residents reported and Special Incident Reports (SIRs) for residents (R1 and R2) submitted by the administrator. LPA met with Maria Roy, licensee, and Olive 'Lynn' Lopez, administrator, and informed the reason for visit. LPA obtained and reviewed R1 and R2's LIC602A Physician's Report, Appraisal and Individual Program Plan (IPP). SIRs indicated the following: 1. Resident (R1) SIR dated 8/11/23 with incident date 8/09/23 - facility received a call from Emergency Department around 4:00 pm. Staff spoke with the doctor, and was told that R1 has an open wound on his finger and bruise on the cheek. R1 was found lying on the front of a building in Hayward. R1 was confused and not able to discuss what happened. A good samaritan brought R1 to the hospital. 2. Resident (R2) SIR dated 8/16/23 with incident date 8/16/23 - R2 was last seen on 8/16/23 between 6:00 am and 6:30 am by R2's roommate leaving their room. Staff searched for R2 around the facility and surrounding neighborhood, and called 9-1-1. On this day, August 17, 2023, LPA obtained copies R1's Hospital Visit Information, R1 and R2's LIC601 Identification and Emergency Contact Information. LPA conducted inspection and interviews. Administrator stated R1 sustained injury on the finger which was stapled and bruise on the cheek. Review of Hospital Visit Information confirmed administrator's statement. R2 is still missing. ........continued on 809C Review of R1's LIC602A revealed R1 has dementia and can not leave the facility unassisted. R2's LIC602A indicated R2 can not leave the facility unassisted, and IPP revealed R2 has history of AWOL behavior. During today's visit, LPA observed all entrance/exit doors without auditory signals. Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $500.00 civil penalty is assessed on this day for deficiency H&S 1569.312(a), and will continue for $100.00 per day until corrected. Deficiencies and plan and proof of correction and civil penalty were discussed with licensee and administrator. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.