Incident investigation·November 6, 2024

On 11/06/2024 at 01:09PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 11/05/2024. LPA met with Rose Constantino, Caregiver, and explained the purpose of the visit. The incident occurred on 11/01/2024 which involved a resident (R1) AWOL'd. LPA interviewed staff (S1) who was present during the time of incident. S1 stated on 11/01/2024 R1 ate lunch around 12:30pm and left the facility without staff being aware. At approximately 1:50PM a paramedic was at the door inquiring if the resident lives at the facility. S1 explained that R1 does live at the facility, and the paramedic stated they received a call from a witness who saw R1 fall near the corner. S1 stated she went out the parking lot with the paramedic and observed R1 in the back of the ambulance on the gurney. While outside the paramedic called R1's daughter and explained the incident, R1 daughter arrived at the facility while paramedics examined R1. R1 stated she was okay and denied going to the doctor, R1 returned to the facility with daughter. LPA obtained the following documents S1’s written statement, R1’s Physician Report (LIC602), R1’s Unusual Incident Reports, Staff Roster, Residents Roster during visit and Incident. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted and a copy of this report and appeal rights was provided. Continue on LIC809D