Incident investigation·June 20, 2025

On 06/20/2025 at 1:45 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident that occured on 06/14/2025. Administrator self-reported the incident on 06/17/2025. LPA met with Administrator, Divine Fernandez, and explained the purpose of the visit. LPA received a self-reported incident report from the facility that indicated that Resident 1 (R1) was allowed to leave the facility by the facility staff. When R1 did not return to the facility, R1's responsible party was informed. R1 returned to the facility couple hours later with a hematoma on the forehead. R1 was sent to the hospital after. During the visit, LPA reviewed R1's physician's report dated 06/05/2025 that revealed that R1 is unable to leave the facility unassisted. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiency within a 12-month period may result in civil penalty. Exit interview conducted. Appeal Rights and a copy of this report provided.