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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366413170
Report Date: 02/12/2026
Date Signed: 02/12/2026 11:18:28 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2023 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230131082321
FACILITY NAME:OPARC ADC-RANCHO CUCAMONGAFACILITY NUMBER:
366413170
ADMINISTRATOR:ITIOLA ADESIGBINFACILITY TYPE:
775
ADDRESS:8333 ROCHESTER AVENUE, #112TELEPHONE:
(909) 948-5592
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:75CENSUS: 72DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Dashawn Parker- Program ManagerTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Neglect/lack of supervision resulting in client sustaining multiple fractures.
Facility staff did not ensure that client received medical services.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Pogram Manager Dashawn Parker and explained the purpose of the visit.

Frist Allegation: Neglect/lack of supervision resulting in client sustaining multiple fractures.

On January 31, 2023, the Department received a complaint with allegation of personal rights violations resulting in C1 sustaining multiple fractures. Additional allegation received was that facility staff did not ensure that C1 received medical services. The Department investigation consisted of review of facility and other records, observations, and interviews with pertinent individuals.
Per facility records, C1 has poor depth perception and requires assistance to step up and off curbs. In addition, it was reported that C1 must have continued supervision due to lack of safety awareness, possibility of seizure and legal blindness.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
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 56-AS-20230131082321
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: OPARC ADC-RANCHO CUCAMONGA
FACILITY NUMBER: 366413170
VISIT DATE: 02/12/2026
NARRATIVE
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 Facility incident report indicated that during a community outing on January 11, 2023, C1 fell trip over a curb twisted left ankle. Interviews revealed that at the time of the fall, facility staff were not close to C1 nor provided C1 with assistance with stepping up and off curbs as needed. As a result of the fall, C1 sustained multiple fractures.

Second allegation: Facility staff did not ensure that client received medical services.

In regard to allegation that facility staff did not ensure that client received medical services, it was revealed that after C1 fell around 10:15 am, facility staff did not seek medical treatment for C1 as needed. Interviews with pertinent individuals revealed that after fall, C1 was seen being carried into donut shop. C1 appeared to be in pain while standing. C1 was also observed as saying “ouch” and ankle had begun to swell. C1 required support on both sides and had “slight” limp, while also moaning and grunting when walking. Facility staff did not contact 911 or seek medical services following incident. Instead, additional facility staff were contacted and arrived at donut shop. Following second staff arrival to donut shop, C1 was taken back to facility. Staff acknowledged that decision was made to bring C1 back to facility and contact responsible party to pick up C1. Around 11:30 am, responsible party was contacted. C1 was picked up by responsible party shortly after 11:30 am and subsequently taken to the hospital. Hospital records reviewed indicated that C1 arrived by ambulance. At the hospital, C1 had severe left ankle pain with “notable swelling.” C1 was unable to bare any weight on ankle. C1 was diagnosed with a closed fracture of the left fibula, fracture of left fibular, and closed fracture of left tibia.

Based upon investigation, above allegations are substantiated. The preponderance of evidence supports that facility did not provide care and supervision to C1 as needed. As indicated, C1 requires assistance to step up and off curbs and continued supervision. This was not provided prior to C1 fall which resulted in C1 sustaining multiple fractures. In addition, facility staff did not ensure that C1 was provided with medical services following the fall. C1 appeared to be in pain with ankle swelling, and was moaning, grunting, and verbalizing “ouch.” Facility staff did not contact 911 or seek medical services. The following deficiencies are cited per Title 22. In addition, an immediate civil penalty will be assessed for $500.00, per Health and Safety Code. In addition, an additional review is being conducted, and additional civil penalty may be imposed by the Health and Safety Code 1548(f)(1)(B)(ii).

An exit interview was conducted where this report was discussed, and appeal rights were provided to Program Manager Dashawn Parker.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20230131082321
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OPARC ADC-RANCHO CUCAMONGA
FACILITY NUMBER: 366413170
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2026
Section Cited
CCR
82078(a)
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Responsibility for Providing Care and Supervision...82078(a)... The licensee shall provide care and supervision necessary to meet the client's needs.

This requirement is not met as evidence by:
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The Licensee has agreed to read over regulation “Responsibility for Providing Care and Supervision 82078(a)”. The licensee will provide training to all staff pertaining to the regulation of responsibility for providing care and supervision to every client in care. As proof the Licensee will provide LPA with the training log indicating that all staff attended the training and have comprehension of the importance when providing care and supervision. Licensee will email training to LPA Guerrero by the POC date listed.
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Based on interviews, and record review, the facility did not provide care and supervision to C1 as needed. C1 requires assistance to step up and off curbs and continued supervision. This was not provided prior to C1 fall which resulted in C1 sustaining multiple fractures. Which posed an immediate health, safety, or Personal Rights risk to clients in care.
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Type B
02/26/2026
Section Cited
CCR
82075(a)
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Health-Related Services…82075 (a)... The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.

This requirement is not met as evidence by:
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The Licensee has agreed to read over regulation “Health-Related Services 82075 (a)”. The licensee has agreed to provide training to all staff pertaining to the regulation health-related services and the importance that every client receives the necessary first aid, medical, dental services, including the arrangement for transportation to nearest available services to every client in care. As proof, the Licensee will provide LPA with the training log indicating that all staff attended the training and have comprehension of the importance regarding health-related services when providing the services and care to the client. Licensee will email training to LPA Guerrero by the POC date listed. In addition, the Licensee will also provide LPA with all CPR/First Aid trainings.
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Based on interviews, and record review, the facility staff did not ensure that C1 received medical services. Following a fall, C1 appeared to be in pain with ankle swelling, and was moaning, grunting, and verbalizing “ouch.” Facility staff did not contact 911 or seek medical services. Which posed an immediate health, safety, or Personal Rights risk to clients 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: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
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