Incident investigation·August 3, 2022

Licensing Program Analyst (LPA) Fernandes-Goes arrived to conduct a case management visit regarding incident report submitted to Community Care Licensing (CCL) for resident R1 which occurred on 7/30/2022. LPA met with Ric Pielstick - ED. Per facility resident R1 AWOL/eloped while under facility responsibility. Resident R1 has a physician's report dated 6/8/2022 diagnostic of dementia and states that resident is NOT able to leave facility unassisted at any time. Resident R1 lives in the assisted living part of facility. Per facility staff resident R1 had her wander guard self removed and walked out of the facility and was found by staff at Grocery Outlet. (see confidential name list, copies, LIC 809-D) Since this incident, facility has reassessed resident R1; discussed plan of care with family; conducted staff in-service for elopement and facility elopement policy and procedure which have been handled to the Department as prove of correction; and elopement drill has been scheduled. (copy on file) Resident R1 will be moving out of the community. At this time resident has escort service and every 2 hrs. check. 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.