Incident investigation·November 4, 2021

Licensing Program Analysts (LPAs) Angela Hood and Michael Hood arrived at the facility today to conduct a case management visit regarding an incident report received by CCLD on 10/22/21. The facility currently does not have any COVID positive cases. Staff wore masks in the facility and LPAs wore N95 masks. Additionally, LPAs were screened upon entry at the facility. On 10/22/21, CCLD received an incident report indicating that on 10/16/21 resident (R1) signed out of the community and left with a friend intending on returning to the facility the same day. R1's Physician's Report LIC602A indicates that R1 is unable to leave the facility unassisted. R1 does not have a conservator. The incident report indicates that R1 did not return the evening of 10/16/21. The facility contacted R1's family and the family contacted law enforcement. Law enforcement arrived at the facility on 10/16/21 and spoke with the Senior Business Community Director regarding R1. R1 returned to the facility the following day, 10/17/21, and the facility reported there were no adverse reactions to R1 missing doses of medication while away. Facility contacted family, law enforcement, and physician to report R1's return to the community. Senior Executive Director, Assistant Executive Director, and staff (S1) spoke with R1 regarding the house rules which state to "notify the Front Desk if you are planning to be away overnight and inform us of your expected date of return, so we know when to expect you. In the event of an emergency, please also provide us with a telephone number where you can be reached while you are away". Moving forward, the facility will obtain a contact phone number for residents in all scenarios where residents leave with an escort/visitor. No deficiencies are being cited during today's visit. Exit interview conducted and a copy of this report was left at the facility.