Incident investigation·May 8, 2024

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management in response to Unusual Incident Report (UIR) for resident (R1) submitted by the administrator to the Department, and forwarded by another LPA to LPA Delmundo on 5/02/24. UIR indicated that at around 8:30 am on 4/21/24, staff (S1) allowed R1 to hang out in the backyard. S1 went inside to get water and when S1 returned. R1 left using the side fence door. Administrator was called who went to look for R1 and called 9-1-1. R1 was returned by the police after at 10:50 am same day. On 5/07/24, administrator submitted another UIR for R1. UIR indicated at around 2:30 pm on 5/03/24, staff (S2) called the administrator and informed that R1 ran away. Administrator gave instruction to S2 to call 9-1-1 and report R1 is missing. Police came to the facility and informed staff (S3) that R1 was found and will be transported to hospital. R1 was discharged back to the facility same day at around 10:45 pm. On this day, 5/08/24, LPA met with Beatriz Munoz, staff, and informed the reason for visit. LPA called and spoke with the administrator over the phone. LPA conducted inspection with Beatriz Munoz. Administrator arrived after about 30 minutes. LPA also met with other staff, Maura White. LPA conducted interviews, and reviewed the documents obtained from the administrator.. Administrator and staff stated R1 didn't sustain any injuries during the 2 incidents. LIC602A Phyician's Report indicated R1 can leave the facility unassisted. During today's visit, LPA observed the auditory signals on the front door and door in the common area at the back leading to the backyard were turned off. Deficiency is cited from Title 22 California Code of Regulations, and listed on 809D. A $250.00 civil penalty is assessed for repeat violation within 12 month period and will continue for $100.00/day if not corrected. ......continued on 809C (page 2) Page 2 Deficiency , plan and proof of correction and civil penalty were discussed with the administrator. Administrator has to leave, and authorized Maura White to sign and receive this report. Also discussed was the updating of R1's LIC625 Appraisal/Needs and Services Plan. Copy to be submitted by 5/09/24. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, LIC421FC Civil Penalty Assessment, and copy of this report provided.