Incident investigation·November 5, 2025

Licensing Program Analyst (LPA) David Roman conducted an unannounced Case Management Inspection. LPA D. Roman identified himself to Licensee, Helen Qian, and discussed the purpose of the visit. LPA D. Roman reviewed the unusual incident report with the licensee, identified the resident was having self harming behaviors. LPA D. Roman conducted a staff interview which revealed the resident was attempting to elope, and exhibited SP, in which law enforcement was contacted and the resident was transferred to UCSD Senior MHS. Staff reported to have a family meeting with the residents responsible party to inform that the resident is in need of a higher level of care. The family was in agreement as the resident reported not wanting to return to the facility. LPA D. Roman along with facility staff toured the interior and exterior of the facility and inspected bedrooms and bathrooms. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. The facility has sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents, medication cart is locked. No pools or bodies of water on the premises. An exit interview was conducted with Facility Licensee, Helen Qian.