Incident investigation·December 20, 2021

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced case management visit. LPA identified herself and stated the purpose of the visit to Caregiver, Carmelita Laxamana. The facility self-reported an incident regarding Resident 1 (R1) to Community Care Licensing on 12/20/21. The facility reported that on 12/19/21, R1 left the facility (AWOL) unattended and has not returned to the facility. Facility staff filed a missing persons report. On today’s date, LPA toured the facility and conducted a health and safety check. LPA briefly spoke with staff present at the facility and requested copies of R1 and facility records. No health or safety risks were observed and no deficiencies were cited at this time. An exit interview was conducted with Caregiver Carmelita Laxamana, a copy of this report and the LIC9058 Licensee/Appeal Rights were provided via E-mai to Administrator, Vida Dacanay. An electronic read receipt verifies receipt of these documents.