Incident investigation·October 16, 2025

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Case Management visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Licensee Vida Dacanay. Today’s visit was in response to an incident which licensee self reported via an LIC624 Incident Report on October 13, 2025. The report described Resident #1 (R1 – See LIC811 Confidential Names List for identification of R1), was Absent Without Leave on October 11, 2025 at approximately 10:00 am. LPA briefly toured the facility, performed a welfare check on residents in care, interviewed staff, and obtained copies of pertinent facility records. No immediate health or safety risks were observed and no deficiencies were cited during this visit. Additional case management will be provided for this incident, including subsequent visits and staff interviews, as needed. An exit interview was conducted, and a copy of this report and Licensee Rights LIC 9058 (03/22)  were left with the Licensee Vida Dacanay, whose signature on this form confirms receipt of these documents.