Incident investigation·August 5, 2022

Licensing Program Analyst (LPA) Michael Hood met with Executive Director (ED), Kayla Young, to conduct a case management visit. The purpose of today's visit is to follow up on an Unusual Incident/Injury Report (SIR) that was received by the Department on 8/4/2022. On 8/4/2022, the Department received an SIR indicating that, on 7/31/2022, residents R1, R2, R3, R4, R5, and R6 opened a delayed egress gate and left the premises at approximately 9:10 AM. The Fire Department was notified around 9:30 AM that a resident had fallen by an unknown witness. At around 10:00 AM, the fire department notified the facility that they had 4 residents and sent 1 resident to the hospital due to fall. 1 resident was brought back by family due to a tracking device. As of 7/31/2022, all 6 residents had returned back to the facility with no reported injuries. After incident, facility contacted the fire department on 8/4/2022 to approve locking gates surrounding courtyard area. ED conducted staff training regarding pager system and door alarms on 7/31/2022 and 8/1/2022. ED also conducted staff training regarding engaging all residents on 7/31/2022 and 8/1/2022. The Department received a Physician’s Report for RCFE (LIC 602) for R1, R2, R3, R4, R5, and R6. A review of all 6 residents’ LIC 602s determined that all 6 residents have a diagnosis of dementia and are unable to leave the facility unassisted. As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Section 87705(c)(4) regarding care and supervision of residents with dementia. The deficiency is listed on 809-D. Exit interview was conducted with ED. A copy of this report and appeal rights were provided. The ED’s signature on these forms acknowledges receipt of these documents.