Incident investigation·April 23, 2025

On 04/23/2025 at 10:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes and Pang Lee arrived unannounced to conduct a case management regarding an AWOL incident report received by the Dept on 04/16/2025. LPA’s met with direct care staff, Netani Tuivu, and LPA's called administrator, Salote Lewis to inform that Community Care Licensing Department (CCLD) is present in the facility. LPA’s explained the purpose of the visit. LPA Hughes read the report to administrator, and administrator gave permission to direct care staff to sign citation. The census is 5 residents with one facility staff. LPA’s reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA’s interviewed administrator, and reviewed incident report dated 04/16/2025. Based on interview and incident report R1 left for a doctor’s appointment with facility staff, upon returning to the facility the resident left the facility unassisted. Per interview with facility administrator, there was only 1 staff present at the facility. Law enforcement was called, and a missing person report was filed. R1's LIC 602, Physician Report dated 09/12/2024 was reviewed by LPA Hughes and it revealed that (R1) is unable to leave the facility unassisted. Interview with Administrator revealed facility's internal plan includes providing supervision for R1 and all other residents in care. Additionally, it was revealed through interview that R1 left the facility, and facility staff did not redirect the resident. As of today’s visit, 04/23/2025 resident has returned to the facility. Based on today's case management, a citation is issued under Title 22, Division 6. An immediate civil penalty in the amount of $500 is issued in addition to citation due to absence of supervision. An exit interview was conducted with direct care staff, Salote Lewis. A copy of this report LIC 809, LIC 809-D, LIC 421IM and appeal rights was provided to direct care staff at the end of the visit.