Incident investigation·October 16, 2023

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a Case Management - Incident visit. LPA met with and explained the reason for the visit with Administrator (AD) Heidi Setty. LPA conducted the Case Management to follow up on an incident which occurred on 10/12/2023. The incident resulted in resident R1 going absent without leave (AWOL). R1 was out of the building approximately 13 minutes. During the visit, LPA interviewed AD and R1 and a record review was conducted. It was confirmed that R1 was placed on the Wandergard program the same day the incident and the resident reappraisal is in process. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D 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.