Incident investigation·September 14, 2021

Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced case management visit. LPA was granted entry into the facility by Carina Ruiz, Staff, to whom she disclosed the purpose of the visit. Abdiaziz Hussen, House Manager, and Ramla Sahid, Administrator, arrived a short time later, and LPA again explained the reason for the visit.. This visit was initiated due to a self-reported incident that occurred on September 12, 2021, in which Resident #1 (R1) [LIC 811 Confidential Names List was provided to identify the resident] was absent without leave (AWOL) from the facility and returned to the facility on the same day with no reported injuries. During today's visit, LPA reviewed resident records and interviewed staff. LPA discovered that although R1 has a diagnosis of dementia and is able to ambulate on his/her own, licensee had no auditory device or other staff alert feature to monitor exits while the one staff who was present provided care to another facility resident. R1's Physician's Report indicates that he/she is not able to leave the facility unassisted; however, R1 was able to leave the facility undetected at approximately 10:00 AM and reach a neighboring street and residence before being located by the local police authority at approximately 10:45 AM. LPA did observe that licensee has an Absentee Notification Plan in place, and the plan was followed. A deficiency is being cited during today's visit and is listed on an LIC 809-D. This report was discussed with Abdiaziz Hussen, House Manager, at the end of the visit. Copies of the report and Licensee/Appeal Rights will be provided to Ramla Sahid, via email, following the visit.