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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610572
Report Date: 09/30/2025
Date Signed: 09/30/2025 04:42:20 PM

Document Has Been Signed on 09/30/2025 04:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:FREE TO BE PROGAMS - OPPORTUNITIES HOME FOR ADULTSFACILITY NUMBER:
197610572
ADMINISTRATOR/
DIRECTOR:		DANIEL MORALESFACILITY TYPE:
735
ADDRESS:6537 WEST AVE. L-7TELEPHONE:
(818) 366-6682
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 4CENSUS: 3DATE:
09/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Daniel Morales - AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On 09/30/2024 at 12:20 p.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility listed above to conduct an unannounced required annual inspection. LPA was greeted by Staff #1 (S1) who granted access. LPA explained the reason for the visit. S1 contacted the administrator. This is an Adult Residential Facility (ARF) Level 4i. The facility has an approved Fire Clearance for four (4) ambulatory clients. The administrator, Daniel Morales arrived shortly after.

A tour of the physical plant was initiated by the LPA at approximately 12:30 p.m., and the following was observed:

Kitchen: LPA conducted a tour of the kitchen and observed there to be sufficient supply of two-day perishables and seven-day non-perishables foods, properly stored. Food storage and preparation areas are clean and clear of clutter. Knives and sharp objects are locked in a cabinet in the laundry room inaccessible to clients in care. LPA observed a fire extinguisher located by the kitchen fully charged. LPA observed the facility telephone accessible to clients on the kitchen counter.

Common Areas: These include the living area, dining area, and multi purpose room. LPA observed these areas to be clean and clear of clutter. The furniture was in good repair and sits the capacity of the facility. In the dining area LPA observed an fire place closed with a screen. Residents’ records, staff records, medication logs, medication and facility files are stored in a locked room located within the multi-purpose room.
Bathrooms: The facility has three (3) bathrooms. LPA observed the bathrooms to be clean and properly supplied with hand soap, toilet paper and paper towels. (Continued on LIC809-C)
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: FREE TO BE PROGAMS - OPPORTUNITIES HOME FOR ADULTS
FACILITY NUMBER: 197610572
VISIT DATE: 09/30/2025
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(Continued from LIC809)Bedrooms: LPA inspected four (4) out of four (4) client bedrooms. Bedrooms are private. LPA observed each client room to be properly furnished with a bed, a chair, a night stand, and have sufficient lighting and storage. LPA observed extra clean linens and towels in a hallway cabinet.

Laundry: Laundry room is located by the kitchen accessible to clients. Detergents, cleaning supplies and poisons are stored in a locked cabinet and closet within the laundry room. LPA observed a washer and dryer that appeared to be in working condition. The laundry room provides access to the garage that is maintained locked, which is used for facility storage.

Surrounding Grounds: Entry and exits were free of obstructions. There is appropriate outdoor furniture for clients to use.

Client/Staff Records: From 1:00 p.m. to 2:00 p.m. LPA reviewed three (3) out of three (3) client records. LPA's review of records revealed two (02) out of three (03) clients did not have medical assessments that included all the required information. At 2:37 p.m. LPA reviewed the facility file and ten (10) out of ten (10) staff files. LPA verified that the facility’s Infection Control Plan was reviewed by the administrator on 09/30/25. An earthquake drill was conducted on 09/09/25, followed by a fire drill on 09/22/25 and Emergency Disaster Plan (Form 610D) were reviewed by the administrator on 09/30/25. The Surety Bond and Personnel Report (LIC 500) was also included in the documentation.

At 3:44 p.m., LPA observed the administrator test the dual smoke and carbon monoxide detectors that are interconnected to other detectors located through out the facility. Detectors were observed to be functioning.

Medications: Centrally stored medications are maintained locked in a room in the multi purpose room. Medications were observed locked. Centrally Stored Medication and Destruction Records were reviewed by LPA at 3:50 p.m., for proper documentation. Facility also keeps medication administration records (MARs).

Deficiency cited today (refer to LIC809-D). Exit Interview Conducted. Appeal Rights provided. A Copy of the Report Issued.
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2025 04:42 PM - It Cannot Be Edited


Created By: Evelin Rios On 09/30/2025 at 04:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 09/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80069(b)
(b) In ARFs , prior to accepting a client into care, the licensee shall obtain and keep on file documentation of the client's medical assessment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 3 client records did not have complete medical assessments which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2025
Plan of Correction
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Administrator agreed to obtain complete physician's reports (lic 602) for two clients and send copies to LPA by POC due date 10/24/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
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