Incident investigation·May 5, 2023

Licensing Program Analyst (LPA) Angela Panushkina conducted a Case Management - Incident visit. LPA met with Administrator and explained the reason for the visit. On 05/04/23, the Department received a self-reported incident report stating that Resident #1 (R1) had left the facility on 05/03/23 and did not return. The incident was reported to police. During today's visit, LPA conducted a physical plant walk through, at approximately 9:00am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA did not observe any immediate health and safety issues during the visit. LPA conducted interview with the Administrator and two (2) staff members. LPA also obtained copies of R1's facility records. Upon review of the physician's report dated 02/15/2023, the report states that R1 has dementia and is not able to leave the facility unassisted. Interview with the Administrator and two (2) staff members revealed that R1 lived at the above facility for almost three (3) years and was very happy with the place. All staff denied seeing changes in R1's behavior. Interview with S1 revealed that on a day of an incident, at approximately 6:30pm, R1 asked S1 to change the TV channel. S1 also informed LPA that around 7:00pm S1 checked on R1 again and observed R1 exercising. When S1 checked on R1 around 7:15pm, S1 observed R1 left the facility through the window and staff lost track of R1. S1 immediately contacted the Administrator and the law enforcement regarding the incident. R1 is still missing and Administrator currently does not have any updated information on R1's whereabouts. LPA will conduct a follow up visit regarding this incident. Exit interview conducted and copy of this report signed and issued.