Incident investigation·July 29, 2025

Licensing Program Analyst (LPA) Pang Lee arrived at the facility unannounced to conduct a case management visit on 07/29/2025. LPA Lee met with Business Office Manager Lisa Johansen and Executive Director Ilona Corpus a nd explained the purpose of the visit. The census is 82. Today's visit was conducted to follow up on a LIC 624 Incident Report received by the Department on July 28, 2025, concerning an Absence Without Leave (AWOL) incident that occurred on July, 26 2025 .The report indicates that Resident 1 (R1) left the facility unassisted during the morning of July 26, 2025. According to an interview with the Resident Care Coordinator (RCC), RCC was notified via walkie-talkie that a staff member observed a resident outside the facility. Per both RCC and the LIC 624 report, R1 was located by RCC down the street at the corner of Annadale Lane and Auburn Road, appearing distraught. At this time, it remains unclear how R1 exited the facility. According to R1’s LIC 602 Physician’s Report, dated November 29, 2024, R1 is diagnosed with mild cognitive impairment and is not capable of leaving the facility unassisted due to their cognitive condition. Based on today's case management visit, a citation is issued under Title 22, Division 6. An immediate civil penalty in the amount of $500 is assessed today July 29, 2025, due to lack of care and supervision and immediate health and risk to R1. During the visit, LPA Lee also followed up on a pending administrator on boarding. Business Office Manager Lisa provided the following documentation related to Staff 1 (S1): · LIC 501 Personnel Record · LIC 9182 Criminal Background Clearance Request · Current California I.D/driver license CONTINUED LIC 809-C · Health screening with TB/Chest x-ray results · LIC 308 Designation of Facility Responsibility · LIC 500 · Current First Aid/CPR certificate · Current administrator certificate LPA Lee did inform Lisa that the following documents are still needed from the facility · High school diploma or equivalent certification · College transcript or degree · LIC 200 signed by the licensee An exit interview was conducted with Executive Director Ilona Corpus . A copy of this LIC 809, LIC 809-D, LIC 421-IM and appeal rights were provided to the facility at the end of the visit.