Hooverwood

During an interview, on 12/29/25 at 2:41 p.m., the DON indicated the facility elopement policy did not include how staff were to respond when a door alarm was activated.

During an interview, on 12/29/25 at 2:58 p.m., Resident B's daughter indicated, on 12/23/25 around 2:30 p.m., she was notified her mom had gotten out of the building and was located down the road.

The resident had also gotten out in November when she resided on the first floor, so she was moved upstairs to the locked unit for safety.

Whenever her mom was having exit seeking episodes, the facility would call her so she could talk to Resident B and help calm her down.

When she exited in November, the facility called her and she was able to talk Resident B to returning inside the facility.

Resident B had now been moved to another locked unit in the facility.

During an interview, on 12/29/25 at 3:14 p.m., LPN 7 indicated, on 12/23/25 sometime after lunch, she was by the nurse's station when she heard an alarm going off.

She was unsure what the alarm was.

Her and another nurse followed the sound to the west door at the end of the hallway.

They looked out the door through the window and didn't see anyone.

She then reset the alarm.

They counted the residents on their unit (which was on the first floor), and they were all accounted for.

She did not know about the elopement until later when the facility called a code purple.A facility document from an electronics company, dated 12/24/25, indicated the company was asked to test all door locking systems that exit the property.

Each door locking system was checked and all systems were working properly.A current facility policy, titled Elopement Prevention and Response Program, dated 1/22 and provided from the Director of Nursing on 12/29/25 at 9:45 a.m., indicated .provide a safe and secure environment for the residents and in the event of a missing resident, ensuring appropriate action is taken.This citation relates to Intake 2700433.3.1-45(a)(1)3.1-45(a)(2)

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