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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610572
Report Date: 05/22/2025
Date Signed: 05/22/2025 10:11:31 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/16/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250516082033
FACILITY NAME:FREE TO BE PROGAMS - OPPORTUNITIES HOME FOR ADULTSFACILITY NUMBER:
197610572
ADMINISTRATOR:DUMAS, JERMARCUSFACILITY TYPE:
735
ADDRESS:6537 WEST AVE. L-7TELEPHONE:
(818) 366-6682
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:4CENSUS: 2DATE:
05/22/2025
UNANNOUNCEDTIME BEGAN:
08:21 AM
MET WITH:Daniel Morales/AdministratorTIME COMPLETED:
10:25 AM
ALLEGATION(S):
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Staff did not provide proper assistance to client in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit to facility to investigate the above allegation. LPA met with staff #2(S2) who granted access. S2 contacted the adminsitrator. LPA met with tthe Administrator, Daniel Morales shortly after and explained the purpose of this visit.

At 8:20 a.m, LPA interviewed S2 and reveiwed and obtained copies of Client #1's (C1's) Glucose assistance chart when it is low or over a certain amount, daily log notes written by staff regarding C1 during the events that took place on 5/14/2025. At 8:41 a.m., LPA Rios conducted a physical plant of the facility. No health or safty hazards observed. When the administraotor arrived LPA conducted an interview and obtained a copy of the client roster, personnel report and Staff #1s (S1's) training regarding C1's health condition and managing it with the assitance of an RN.
(Continue to LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 31-AS-20250516082033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: FREE TO BE PROGAMS - OPPORTUNITIES HOME FOR ADULTS
FACILITY NUMBER: 197610572
VISIT DATE: 05/22/2025
NARRATIVE
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(Continued from LIC9099)
Allegation: Staff did not provide proper assistance to client in care. In regards to the allegation it was reported that when C1 experienced a hypoglycemic event and Staff #1(S1) failed to follow written protocol for handling such event which prolonged it by over 2 hours. LPA's review of the glucose chart outlines the steps a staff would have to take when a scenario arises for either a low glucose or high of a certain amount. LPA observed the chart was easily accessible to staff. LPA's review of the S1's daily log notes reveal they did the opposite that was on the flow chart indicating S1 may have confused the less than symbol with the more than symbol. Interviews with the administrator and staff revealed training was conducted when C1 was admitted to the facility. A copy of S1's training corroborates S1 participated in training on 03/05/2025 regarding C1's condition. Interview with the administrator further revealed there was communication between S1 and an RN over the phone first by phone call then by text messages. Review of S1's daily log revealed they contacted the RN after the second incorrect step was taken by S1. Times on the daily log and confirmation from administrator corroborate the event lasted approximately 2 hours. Although C1 was able to return to normal range, the response to C1's hypoglycemic event was prolonged by S1's failure to follow written protocol. Therefore, allegation is substantiated. Administrator stated they have removed S1 from providing care to C1 and training will be scheduled for all staff regarding C1's health condition and management.

Deficiency issued, refer to 9099-D. Exit interview conducted. Copy of this report and appeal rights provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250516082033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: FREE TO BE PROGAMS - OPPORTUNITIES HOME FOR ADULTS
FACILITY NUMBER: 197610572
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2025
Section Cited
CCR
80092.8(a)(7)
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(a) A licensee... may accept or retain a client who has diabetes if all of the following conditions are met: (7)The licensee ensures that all facility staff who provide care... in taking appropriate action for client safety. This requirement is not met as evidenced by:
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The administrator agreed to conduct in-service training regarding C1's condition and maintenance of condition. Sign-in sheet with topic's covered will be provided to LPA by POC due date.
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Based on interviews and record review, staff failed to follow the appropriate steps when C1 experienced a hypoglycemic event which posed a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3