Incident investigation·October 2, 2024

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Incident visit. LPA met with Manager, Gabriela Zamora and discussed the purpose of the visit. On 09/30/24, the facility self reported an incident involving Resident #1 (R1). The Incident Report stated a on 09/26/24, a resident alerted facility staff at approximately 10:30am that R1 was walking in the middle of the road. At approximately 10:40am staff went to search for R1 but R1 was gone. R1 returned to the facility at approximately 2pm with no injuries. The Manager explained R1 leaves the facility on a regular basis and signs out and signs back in using their facility log. Manager stated R1 is capable of being in the community unassisted and knows the area well. The Manager also stated R1 has a cell phone but refuses to answer it when staff call. The facility also has R1's friend's contact information and will get a hold of R1's friends to verify R1's location. There have never been any issues with R1 being in the community. Manager believes R1 is able to be in the community unassisted and will discuss the issue with R1's Physician to update the Physician's Report that currently indicated R1 is not allowed to leave unassisted. Once the facility was made aware R1 was out of the facility and didn't return they followed their Absentee Notification Plan. The facility cannot force a resident to remain in the facility. The facility acted appropriately by following their absentee plan. No deficiencies were issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Manager, Gabriela Zamora whose signature below confirms receipt of these rights.