Incident investigation·July 3, 2023

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Priscilla “Lily” Dacanay. LPA then met with the administrator's assistant, Edgar Dacanay, who arrived later during the visit. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 04/10/2023). According to the LIC624: on 04/08/2023, Resident #1 (R1) eloped from the facility (left without staff supervision). [See LIC 811 Confidential Names List for a description of person identifiers used in this report.] Staff immediately notified law enforcement, who located and returned R1 to the facility unharmed/uninjured. As of CCLD’s 07/03/2023 site visit, R1 had since moved out of the facility and was not present. During today’s visit, LPA performed a facility tour and welfare check on the remaining residents, finding no immediate safety concerns. LPA also reviewed resident care records and interviewed relevant facility staff. According to their latest LIC602 Physician’s Report (dated 03/10/2023): R1 was diagnosed with Schizophrenia and Dementia, and their doctor determined that they were not able to safely leave the facility unassisted. Multiple staff interviews corroborated: On the date of the incident, R1 was initially exercising/walking around the facility’s front and back yards, but still remained on the facility premises. Staff visually checked on R1 regularly. Upon first observing that R1 had walked off-property, staff timely phoned law enforcement, R1’s “emergency contact” person, R1’s case worker, and CCLD. While law enforcement searched for R1, facility staff also drove around the adjacent neighborhoods to search for them. Law enforcement located R1 around 1.5 hours later at a nearby park and returned them to the facility unharmed/uninjured. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] R1 had exercised on prior occasions in the facility’s yards, without safety problems. A preponderance of evidence does not exist to show that licensee did not provide needed observation to R1, or that licensee did not meet reporting requirements. No deficiencies were cited for the incident itself. However, during today’s record review (and corroborated by staff, LPA observed that: a) Licensee did not possess an Absentee Notification Plan for R1, Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), Resident #5 (R5), or Resident #6 (R6), as was required; b) Licensee did not possess evidence of receipt of resident’s Personal Rights by R1, R2, R3, R4, R5, or R6, as was required; and, c) Licensee did not possess an initial personal property inventory for R1, R2, R3, R4, R5, or R6, as was required. Additionally, d) Licensee did not possess a completed LIC602 Physician’s Report (or equivalent medical assessment) for R3, R4, and R5; and e) R6, who was diagnosed with Dementia per medical records, did not have an LIC602 Physician’s Report (or equivalent medical assessment) completed/updated within the last year, as was required. Deficiencies were cited per California Code of Regulations, Title 22, and California Health and Safety Code (refer to the attached LIC 809-D). Plans of Correction were jointly developed with the licensee. LPA also provided Technical Assistance to Licensee regarding staff auditory and/or alert devices on exit doors. An exit interview was conducted with Edgar Dacanay, to whom a copy of this report, the LIC809-D pages, the LIC9012-TA page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.