Incident investigation·September 22, 2023

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Case Management – Incident visit for the purpose of following up on a self-reported incident that occurred on 09/18/2023. LPA met with Business Office Director Kailey Vanderwall. Executive Director was not available during today's visit, however Ms. Vanderwall is authorized to sign all licensing reports. LPA explained the reason for today's visit. On 09/19/2023 an Unusual Incident/Injury Report was received via e-fax at the Woodland Hills Regional Office. LPA reviewed the document, which indicates that Resident #1 (R1) left the community unsupervised and was found a block away. R1 resides in Assisted Living, however has a dementia diagnosis and is unable to leave the facility unassisted. During today's visit, LPA along with Business Office Director toured the facility at 08:52AM, interviewed staff between 09:33AM to 10:30AM as well as at 12:31PM, and LPA obtained copies of pertinent documents. Additionally, LPA, along with Health Services Director and Business Office Director tested the Wanderguard alert beginning at 11:11AM, and LPA interviewed residents from 11:44AM to 12:13PM. During Wanderguard testing, it was observed that both the auditory alarm and electronic alert did not function on the Exit door next to Room 135. LPA will return at a later date to continue the investigation into the incident that occurred, due to needing additional clarifying information from the Executive Director and to interview additional staff present at the time of the incident. Pursuant to Title 22 CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Business Office Director was informed that failure to correct the deficiency may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.