Incident investigation·August 4, 2022

Licensing Program Analyst (LPA) Fernandes-Goes arrived to conduct a case management visit regarding two incident reports submitted to Community Care Licensing (CCL) for R1 & R2 which occurred on 6/16/2022. LPA met with Cynthia Virata - Administrator. On both occasions resident R1 & R2 AWOL/eloped while under facility responsibility. Resident R1 has a physician's report dated 2/3/2021 diagnostic of dementia and R2 dated 9/21/2020 diagnostic of MCI which states that residents are NOT able to leave facility unassisted at any time. Per facility staff resident R1 walked out of the facility and was found by staff on sidewalk on Tamalpais Ave while resident R2 was found by staff at wine festival. It seems that both residents left facility together. (see confidential name list, copies, LIC 809-D) Since this incident, facility has conducted staff training for elopement and facility elopement plan in which both have been submitted to the Department as prove of correction. (copy on file) Precautions have been taken by facility to avoid any other incident of elopement. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. Appeal of Rights Given.