Incident investigation·September 4, 2025

On 9/4/2025 at 12:00 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to conduct a case management regarding an elopement incident report received by the Dept on 9/3/2025. LPA met with facility staff Ula and the facility administrator Veniana Banuve. LPA explained the purpose of the visit. The current census is 6 residents with 1 facility staff. LPA interviewed facility staff, regarding (2) separate incidents of elopement on 9/3 and 9/4/2025. Based on interview on 9/3/2025 facility staff was assisting another resident with changing their undergarments. Facility staff seen two residents R1 and R2 standing outside with their bags and a walker. Facility staff tired to redirect residents back into the facility. Staff contacted the administrator Veniana to assist with the residents leaving the facilities. Facility staff ran down the street to try to redirect residents but was unable to have the residents follow them back into the facility. Facility staff contacted R1's Responsible Party (RP) who was able to talk with both residents and persuade them to come back into the facility. On 9/4/2025, resident (R2) asked facility staff if they could go to Walmart and to the Bank. Facility staff told the resident that they had to wait until the administrator came to transport them. The resident spoke with the administrator and facility staff who warned against leaving the facility unassisted. However resident (R2) still left the facility despite being warned not to leave. R1 and R2's LIC 602, Physician Report was reviewed by LPA Hughes and it revealed that Resident (R1) and (R2) is unable to leave the facility unassisted. Interview with Administrator revealed the facility's internal plan includes providing supervision for all residents in care, including transportation to and from appointments. Continuation 809-C Per administrator, Law enforcement was contacted to report the missing resident, and a report will be sent to CCLD to report the incident of elopement on 9/3/2025 and 9/4/2025 at the facility. As of 9/4/2025 R2 has eloped from the facility for the second time, and at the time of this report R2 has not returned. 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 for the dates of 9/3/2025 and 9/4/2025 due to absence of supervision. An exit interview was conducted with administrator Veniana Banuve. A copy of this report LIC 809, LIC 809-D, LIC 421IM and appeal rights was provided to Veniana at the end of the visit.