Facility Evaluation Report

Licensing Program Analyst (LPA) Cassandra Mikkelson and Licensing Program Manager (LPM) Laura Munoz arrived to the facility today to follow up on an incident that occurred at the facility on 11/27/2025. LPM Munoz spoke with Administrator Gary Johnson via phone to inform of visit.

On 11/27/2025, S1 assaulted R1 resulting in resident sustaining closed fracture of left orbit and closed fracture of left condylar process of mandible. Interviews and records review indicated that S1 and R1 were watching a football game drinking alcohol. At some point during the game, S1 and R1 got into a verbal altercation. R1 pushed S1 at which time S1 hit R1 in the face causing significant injury. This incident was observed by other another staff member who separated S1 and R1. When the licensee was made aware of the altercation, S1’s employment at the facility was terminated. On 04/14/2026, the RO served the facility with an immediate exclusion notice for S1.

As a result of this visit, a deficiency was cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. An immediate civil penalty in the amount of $500 was assessed per Health and Safety Code 1548 for a violation regarding personal rights. Deficiency is listed on 809-D page.

The licensee was informed during today’s visit that a civil penalty is under review and may be assessed at a future date according to Health and Safety Code §1569.49.

Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.