complaint·June 18, 2021

On 04/23/2021, 3 residents were interviewed. 3 out of 3 residents stated they have never been left alone at the facility. 1 out of 3 residents stated they left the facility without staff when they weren’t supposed to. 2 residents were not able to be interviewed because they were sleeping or refused to be interviewed. On 04/23/2021, 2 staff were interviewed. 2 out of 2 staff stated they check on the residents often, and there is always a staff working at the facility. 2 out of 2 staff stated there are door alarms at the facility, and they were working properly before the incident. 1 out of 2 staff stated S1 did not hear the alarm go off and did not hear or see R1 leave the facility. S1 stated when completing night rounds, S1 noticed R1 was not in R1’s bed and was not able to locate R1. On 04/23/2021, a tour of the facility was conducted. Door alarms were observed and working properly. Administrator opened the door and the alarm made a sound immediately. Records review were also conducted. On 04/16/2021, the Department received an incident report stating on 04/15/2021, staff was not able to locate R1 in R1’s bed and was not able to find R1 in the facility. San Jose Police Department was notified, and a missing person’s report was made. R1’s Physician Report was also reviewed and showed that R1 is not able to leave the facility unassisted. San Jose Police Department Incident Report was also reviewed. The report stated that on 04/15/2021, the facility reported R1 missing. A witness found R1 and reported it to the San Jose Police Department, where an officer responded and verified it was R1. The Department has conducted an investigation of the above allegation. Based on interviews, observations, and records review, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation to be SUBSTANTIATED. A deficiency is being cited. See LIC 9099-D. Exit interview was conducted with Administrator Belinda Devano. This report, LIC 9099-D and Appeal rights were discussed and a copy was left with Administrator Belinda Devano.