Incident investigation·October 18, 2021

Licensing Program Analyst (LPA) Lopez arrived unannounced for the purpose of following up on an incident involving a self reported incident submitted to Community Care Licensing (CCL). On 10/10/21 R1 went AWOL from the facility. LPA met with Administrator, Paul Oseso and Wellness Nurse, Florence Guiyab. LPA spoke with Administrator and Wellness Nurse and reviewed records. Physician's report indicates that the resident cannot be in the community without assistance from the staff. It was reported that R1 left facility. Med tech went to get R1. R1 was then walking back with staff. Facility reported to physician, responsible party and Community Care Licensing. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with , Administrator Paul Oseso and appeals right given.