Senior Care Records.

Facility Evaluation Report

Young Adult Family Home, San Miguel04/03/2025Licence 405850543

Capacity4
Census4
Date signed04/03/2025 03:47:23 PM
Name of licensing program analystGarrett Haner-Tomasko
Name of licensing program managerKelly Burley
The inspector’s account

At 1:00pm on 04/03/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced to the facility to conduct a case management visit along with Tri-Counties Regional Center. LPA met with Licensee, Diane Young and announced the reason for the visit.

On 04/02/2025 around 09:30am, Licensee reported by phone to Tri-County Regional Center and at 10:10am to Community Care Licensing that on 04/01/2025 at approximately 05:15pm Client 1 (C1) became violently agitated. Licensee and Client 2 (C2) were sitting at the kitchen bar and clients 3 (C3) and 4 (C4) were sitting at the dining room table when C1 came into the dining area upset. Licensee asked C1 if he could be quiet while Licensee and C2 conduct a video conference at the bar. C1 said no. When Licensee turned their attention back to C2, C1 threw a manikin at Licensee hitting them on the back and head, leaving no visible injury. C1 proceeded to throw a dining room chair across the living room. Licensee told C2 and C4 to go to their rooms and lock themselves in their rooms. Licensee took C3 into the staff bedroom and locked the door. Licensee could hear banging from outside the bedroom door. At around 07:00pm it became quiet and Licensee came out of the staff bedroom to find C1 in their room eating food.

LPA interviewed Licensee. Clients were at day program. LPA and Licensee discussed de-escalation techniques for C1 and calling 911 or the crisis unit if C1 has future episodes.

No deficiencies were issued during this visit. The LPA may return at a later date if it is determined deficiencies are warranted.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction