complaint·March 27, 2025

ALLEGATION: Resident eloped due to lack of supervision from staff INVESTIGATION FINDING: Substantiated During investigation, the department conducted interviews of facility staff (S1, S2), reporting party (RP) and reviewed resident (R1) documents. On 03/24/25, LPA interviewed reporting party (RP) who stated that a neighbor approached him on 03/23/25 around 02:14PM and informed him that a resident (R1) knocked on their door and told them to contact the police because her home is being invaded. RP stated that it was known to the neighbors that the facility cares for elderly residents. The neighbor walked over to the care home and explained the situation with staff (S1, S2) who were completely unaware that anyone from the facility was missing or has left the home. LPA interviewed S1 who confirmed that they did not know that R1 left the facility on 03/23/25 until the neighbor knocked on the door and told them R1 was at his home. RP stated the neighbor brought R1 safely back to the facility around 3PM. Based on observations and interviews which were conducted and record review(s), the department has substantiated the allegation that resident eloped due to lack of supervision from staff. The preponderance of evidence standard has been met. Therefore, the above allegation was found to be substantiated. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.