Incident investigation·July 25, 2024

On 07/25/2024 at 2:50 PM Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 05/30/2024. LPA met with Care Director, Yelba Havelhorst and Health Services Director, Davinderjit Singh and explained the purpose of the visit. CCL received an Unusual Incident Report that reported that Resident (R1) eloped from the facility on 05/26/2024 at around 7:15 AM. Staff (S1) stated that the morning shift observed R1 sitting on the front chair near the concierge area. S1 stated that they think R1 left when the morning staff was coming inside the front door. S1 stated that R1 has 2 (two) daughters that live out-of- state and the daughters check the GPS that is located on R1's watch. S1 stated that the Med Tech was looking for R1 at around 8:00 AM to give him his morning medication but he was not in his room. S1 stated that the staff were looking for R1 inside and outside the building. S1 stated that security from San Francisco International Airport (SFO) called and spoke to the facility's concierge and indicated that they found a person that matched the description. S1 stated that R1's daughters checked the GPS and that is when they discovered that R1 was at SFO. S1 stated that the daughters called SFO security and gave a description of R1. S1 stated that a friend of R1's ex-wife was the person that went to SFO to pick up R1 and brought R1 back to the facility. S1 stated that the facility did not know that R1 was missing until SFO security called them. LIC809-C Continued... LIC809-C Continued... LPA obtained the following documents: Physician's Report, Residence and Care Agreement, Progress Notes, Two Hour Check, Resident Emergency Information Form, Physician's Orders, Individualized Service Assessment, Individualized Service Plan (06/13/24 and 07/09/24), Sign-out sheet and Aegis Living Elopement Response Protocol. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided