Incident investigation·April 4, 2024

On April 4, 2024, Licensing Program Analyst (LPA) Murial Han conducted an unannounced case management visit to follow-up on an incident that was report to CCL by the facility. LPA met with Resident Service Director, Rowena Cancino and Administrator, Glenda Bertccui. LPA explained the purpose of today's visit. On March 28, 2024, facility reported that facility received a call from the post office reporting that one of the residents was there. Subsequently, facility director went to the post office to pick up the resident(R1). However, someone had already called 911 and resident was transferred to the hospital for further evaluation. During today's visit, LPA interviewed the Resident Service Director and the Administrator who stated that R1 usually gets transported by the facility van when R1 wanted to leave the facility; 2 days prior to the incident, R1 was informed by facility staff that the van would be out of service and if R1 could hold off on conducting outings. During the day of the incident, R1 was persistent with leaving the facility to conduct some personal business. As R1 was signing out at the front desk, the receptionist reminded R1 that R1 was not to leave the facility unassisted. However R1 left by him/herself without further actions performed by facility to ensure R1's safety. Based on R1's Physician's Order (LIC 602), R1 was not able to leave the facility unassisted. Therefore, deficient is cited under California Code of Regulations, Title 22 as the facility did not ensure care and supervisor was provided while R1 was out of the facility. Civil penalty of $250 will be assessed today for repeat violation as this deficiency was cited on 7/20/2023. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed the administrator; a copy is provided with the appeal rights.