Incident investigation·December 22, 2021

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit at the facility. LPA Lopez identified herself and was granted entry by Jilian Rogers, Concierge. LPA stated the purpose of the visit and reviewed the basic elements of the complaint with Diane Domingo, Executive Director. The facility self reported an incident regarding Resident #1 (R1) (See LIC 811 Confidential Names List) to Community Care Licensing on December 21, 2021. The facility reported that on December 7, 2021, R1 eloped from the facility unnoticed and Police Department returned the resident to the facility the same day with no injuries noted. During today’s visit, LPA conducted interviews and requested and obtained client records. This case management needs further follow-up. No deficiencies were cited during this visit. An exit interview was conducted with Executive Director Domingo and a copy of this report, LIC 811 and Licensee/Appeal Rights (LIC 9058 01/16) were provided via email. An electronic receipt of confirmation was requested to be sent upon receipt of the documents.