complaint·February 20, 2024

Allegation: Resident eloped from the facility because staff did not provide adequate supervision. It is alleged that R-1 eloped from this facility due to staff not providing adequate supervision. (3) out of (4) staff interviews revealed that R-1 was in the facility on 01/27/2024 and was reported missing on 01/28/2024. Staff interviews revealed that a missing person’s report for R-1 was filed with the local police department and an incident report was submitted to community care licensing. (3) out of (4) staff interviews revealed that staff continue to have communication with the local police department and local hospitals in attempts to locate R-1. (3) out of (4) staff interviews also revealed that in October of 2023, R-1 was out in the community for an extended amount of time prior to this latest incident. A missing person’s reports was filed with the local police department and reports were also submitted to community care licensing. Per information obtained, R-1 was located and taken to a hospital for treatment of a medical condition not related to a cognitive impairment. Staff interviews revealed that R-1 is self-responsible and goes out to the community daily throughout the day independently. R-1’s Physician Report indicates that R-1 does not have a cognitive impairment and R-1 is able to leave the facility unassisted. R-1 only had their initial appraisal/needs and services plan upon admission (dated 12/27/2021) and per S-1, R-1 does not have an updated plan as R-1 has not had a change in condition. Per R-1’s appraisal/needs and services plan, R-1 is self-responsible and is able to perform activities of daily living independently. Interviewed staff indicated that R-1 has not had a change of condition. LPA obtained a chronology for both incidents reflecting the dates the facility called local hospitals and/or local jails in attempts to locate R-1. (1) out of (4) interviewed residents indicated that R-1 appeared to be their normal self, went in and out of this facility independently and did not appear to have a cognitive impairment. (3) out of (4) interviewed residents indicated they do not know R-1 and that residents keep to themselves. Interviewed staff also indicated that R-1 kept to R-1’s self. Interviews conducted and documentation reviewed do not corroborate this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of the Appeal Rights and this report was provided to Cynthia Flores.