Complaint·April 15, 2024

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the initial 10-Day visit. LPA met with and explained the reason for visit and elements of the allegation with Assistant Administrator (AD) Lisa Pua. LPA investigated the allegation and delivered complaint findings during the visit. On 4/5/2024, Resident (R1), who has Dementia left the facility without staff being aware. While out of the facility, R1 sustained injury and was treated at the hospital. Based on interview and record review of R1's file, the preponderance of evidence standndard has been met, therefore the above allegations are found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D. An immediate Civil Penalty is being assessed on the attached LIC421M. An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD, whose signature on this form confirms receipt of these documents.