Incident investigation·April 29, 2022

Licensing Program Analyst (LPA) Natasha Persaud conducted a Case Management - Incident visit. LPA met Medication Technician Supervisor, Yahaira Garduno and stated the purpose of the visit was to follow up on an incident report. LPA also contacted Administrator, Rocio Granda via telephone to discuss the incident. On 04/28/22, the facility submitted a self-reported incident involving Resident #1 (R1). The incident report stated R1 left the facility on 04/27/22 and did not return. While out in the community, R1 was transported to the hospital. The facility contacted R1's responsible party and local law enforcement. During today's visit, LPA briefly toured the facility, obtained records and interviewed staff and residents. A review of records indicated R1 does not have a current Resident Appraisal on file. The last appraisal on file for R1 was dated 11/29/18. A deficiency was issued and cited on the attached 809D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Medication Technician Supervisor, Yahaira Garduno whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]