Incident investigation·June 20, 2022

On June 20, 2022, Licensing Program Analyst (LPA) Murial Han conducted an case management visit regarding an incident that was reported to CCL. LPA met administrator and explained the purpose of the visit. On June 3, 2022, CCL received a LIC624 (Unusual Incident/Injury Report) from the facility regarding resident #1 was delivering mail to resident #2 and was told by resident #2 not to touch the mail that does not belong to resident #1. Resident #1 appeared upset, left the facility and went to a nearby store where resident #1 was witnessed by a bystander performing an unusual activity which triggered the bystander to call 911. In addition, the bystander also called the facility to confirm resident #1 was a resident at the facility. After the facility was notified by the bystander of a potential resident, facility staff went to the nearby store and confirmed that it was resident #1. Resident #1 returned to the facility later on that same day after the hospital stay. During today's visit, LPA interviewed the administrator and collected some documents and addition documents- Care Plans, and medical records will be provided by 6/21/22. This incident requires further follow-up. This report is reviewed and discussed with the administrator. A copy is provided.