Facility Evaluation Report

06/17/2026 11:55 AM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with administrator Shara King. Today’s visit is regarding an incident that occurred on 05/14/2026.

It was reported that on 05/14/2026 4:15 AM Client 1 (C1) was playing music at maximum volume in their room, which woke up all of the other residents. Staff 1 (S1) called the on-call administrator, Staff 2 (S2, and Staff 3 (S3). S2 and S3 arrived and attempted to reason with C1 to turn down the radio. C1 stood up and attempted to stop both staff, punching S2 twice in the process. S3 contacted EMS when C1 left the facility to walk down the middle of Luther Road. C1 began making suicidal ideation comments. S3 and S2 attempted to intervene, following C1 while using their phones to alert oncoming traffic over a situation in the road and attempted to move C1 out of the street. After a short time, C1 pushed S2 and S3 out of the way, jumped in front of an oncoming vehicle, made contact with the side of the vehicle and rolled several times on the ground. C1 remained on the ground until EMS arrived. EMS transported C1 to the hospital for medical evaluation and subsequently placed on a 5150 hold by Tehama County Crisis Response.

During the course of the investigation, it was learned that C1 attempted to walk in front of cars three times and was not struck by a vehicle but was close enough to make contact with one vehicle which knocked C1 to the ground. C1 was in the hospital for about one month after the incident for mental health observation. C1 is now back living in the facility.

In order to prevent this from happening again the facility has increased mobile crisis unit intervention for C1. Any time C1 starts to exhibit signs of depression the mobile crises unit is called. The mobile crisis unit provides counseling and assistance for C1. C1's physician has modified their medication to reduce their anxiety level. C1 has been to two follow-up appointments with their physician to monitor their medications.

No deficiencies were cited as a result of today’s visit. Exit interview conducted and a copy of the report was provided to administrator Micah Carey.