Incident investigation·October 26, 2022

On today's date Licensing Program Analyst (LPA) Rosie Quiroz conducted a Case Management- Incident inspection visit. LPA Quiroz was greeted and COVID-19 screened by front desk receptionist and met with Operations Manager Itzayana Barba. LPA Quiroz along with Operations Manager Itzayana Barba conducted a facility tour of the interior and exterior of facility premises. During today's visit, LPA Quiroz conducted interview with Operations Manager Barba and requested the following for review for (R1): Physician Report, Identification Form and Needs and Services Plan. The purpose of this Case Management- Incident visit was to follow-up on a Special Incident Report received in the Orange County Regional Office on 10/18/2022 , dated 10/13/2022 regarding Resident 1 (R1) leaving the facility unassisted. Per file review of Resident 1's physician report dated 9/13/2022 page 4 of 6; (R1) has a primary diagnosis of Dementia with behavioral disturbances, and indicated not able to leave the facility unassisted. For this visit, deficiency was observed and citation was issued per Title 22 Division 6 of the California Code of Regulations. (SEE LIC 809-D) Civil penalty assessed on today's date. LPA Quiroz conducted an exit interview with Operations Manager Barba. LPA Quiroz discussed the deficiency, citation, Civil Penalty and Appeal Rights. Copies of this report, Deficiency (809-D), Civil Penalty (421 IM) and Appeal Rights and copy of CCR 87705-Care of Persons with Dementia were provided at exit.