Incident investigation·January 13, 2025

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required annual inspection and in conjunction conducted this case management visit at the facility. LPA Lopez identified herself and was granted entry by caregiver Manuel Santiaguel. LPA stated the purpose of the visit and reviewed the basic elements of the visit with Administrator Frederick Locsin and Licensee Donnah Locsin who later arrived and joined the visit. The facility self-reported an incident regarding resident #1 (R1) (See LIC 811 Confidential Names List) to Community Care Licensing on December 26, 2024. The facility reported that on December 19, 2024, R1 eloped from the facility but staff #1 (S1) found the resident a few houses down with neighbors who had initiated emergency response. Although they did not find any signs of trauma, the resident's responsible party and Licensee agreed to have the resident seen and checked. R1 returned to the facility on December 22 nd . R1 was admitted to home health upon their return to the facility. During today’s visit, LPA toured the facility, conducted staff and resident interviews, and conducted a welfare check for resident in care, and observed there were no immediate safety concerns. Resident Physician’s Report, dated 1/20/24, showed that the R1 is ambulatory and has a diagnosis of dementia. Further review of the Physician’s Report indicated that the resident is not at risk if allowed to leave the community unsupervised due to dementia or cognitive decline. Further review of the Physician's Report showed that the R1 is able to communicate their needs and is able to follow simple directions. According to the interviews, the Licensee said that they have never had an elopement, and this was their first elopement. Licensee did not have an absentee notification plan on file as there was no prior need for one. LPA provided Licensee technical assistance regarding the absentee notification plan. This case management requires further follow-up. No deficiencies were cited during this visit. An exit interview was conducted with Licensee Donnah Locsin and a copy of this report, LIC9102-TA, LIC 811 (confidential names list) and Licensee/Appeal Rights (LIC 9058 01/16) were provided to the Licensee at the conclusion of the visit. The signature below confirms the documents were received.