Incident investigation·September 11, 2024

On 09/11/2024 around 9:50 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a case management. LPA met with Douglas Blake, Executive Director (ED) and explained the purpose for the visit. On 09/10/24, Licensing Program Analyst (LPA) L. Holmes requested R1’s LIC602 and LIC624 related to the R1’s Elopement. On 09/09/24, Licensing Program Analyst (LPA) T. Syess-Gibson conducted a phone interview per the request of Licensing Program Manager (LPM) to inquire about an AWOL that took place on 09/08/24 around 4:30 PM. LPA T. Syess-Gibson spoke with (S1), and explained the purpose of call. S1 offered to take the number and have Douglas Blake, Executive Director (ED) call back. At around 11:05 AM LPA T. Syess-Gibson received a call from Douglas Blake, Executive Director advising that the AWOL happened on 09/08/2024 at approximately 4:30pm with an Assisted Living Resident #1 (R1). S2 noticed R1 was missing and had left the community without signing out. The Berkeley Fire Department found the resident around 6:45-7:30 PM, and took the R1 to Alta Bates Hospital for observation hospital for observation. Per ED, the Aftercare Summary Report indicated a change in condition for R1 as an altered mental status. ED state that he has a call scheduled with the family to discuss R1’s long term care needs. LPA T. Syess-Gibson advised ED to send in the incident report as soon as possible. LPA T. Syess-Gibson provided ED with her email address and the office’s general email address. On 09/11/24 during the visit, ED confirmed that R1 can't leave unassisted and R1 may have left during the change of shifts at the Concierge area. Training on policies and procedures took place on 09/11/24. Unannounced drills will follow monthly along with bringing the teams together to review the policies, procedures, timelines, and debriefing regarding AWOLs/Elopements. continued on LIC809C... continued from LIC809... R1's responsible party and Berkeley Police Department were alerted immediately; however, Community Care Licensing was not notified until 09/09/24. -At 12:10 PM, LPA interviewed S2 and confirmed that S3 stated that he/she tested positive for COVID on or around 09/07/24; the incident was not reported to CCLD via telephone or fax. Based on information obtained, deficiencies are cited from Title 22 California Code of Regulations and listed on LIC 9099D. Failure to submit proof of correction by plan of correction due date, and any repeat violations within a 12-month period may result in civil penalties. An immediate civil penalty was assessed of $250 is hereby assessed on 09/11/2024. Exit interview conducted, Appeal Rights, and a copy of this report provided to Douglas Blake, Executive Director.