Incident investigation·April 28, 2023

At approximately 2:45PM, Licensing Program Analyst (LPA) Felias, arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator/Executive Director, Melon Rivera. The purpose of the visit was to follow up on a self-reported incident that was submitted to Community Care Licensing (CCL). LPA reviewed the following report with Executive Director: Incident Report 1: CCL received an incident report on 04/27/2023. The report states that on 04/26/2023, the facility received a phone call from Local Law Enforcement notifying them that Resident 1 (R1) was found outside of the community with an observed head wound. Local Law Enforcement informed the facility that R1 would be transported to the hospital. Facility made all appropriate notifications per regulation. LPA discussed R1 with Executive Director. Per conversation with Executive Director, R1 likes going on walks by themselves and does not like participating in the community walks that the facility schedules as an activity. LPA requested and reviewed documents. Review of R1's LIC602/Physician's Report states that R1 is able to leave the facility unassisted and without staff supervision. As of today, 04/28/2023, R1 has returned from the hospital and is back at the facility. R1 has been observed to be at baseline and is doing well. Facility has continued to communicate with R1, their Responsible Party, and their Physician regarding R1's care needs. LPA conducted a walk through with Executive Director. No Deficiencies Cited during visit. Exit interview conducted. Copy of report and LIC 811 (Confidential Names) discussed and provided to Administrator. Signature on form confirms receipt of documents.