RAMONA, Calif. (KGTV) — A Ramona group home that treats patients with serious mental disorders has come under state scrutiny following a Team 10 investigation.
At issue was whether a plan was implemented to have a mentally ill resident eat and take his medication out in the cold because he smelled.
State records and internal emails obtained by Team 10 show one of the residents living at Changing Options was refusing to shower in early January.
The person, according to one staff member, wore the same clothes every day and smelled so bad that employees and others didn’t want to come near him.
So, they came up with a plan.
The client would be encouraged to eat and take his medicine outside until he showered.
A string of emails, including one from a senior staff member, shows this would begin Jan.6.
It was near freezing temperatures in Ramona during breakfast at around 8 a.m. that day, and a frigid 46 degrees at dinner around 6 p.m.
It’s against state regulations to have a mentally ill client at an adult residential facility eat outside in inclement conditions, according to the California Department of Social Services.
State regulations say these facilities must always have a comfortable temperature for clients.
Furthermore, meals must be served “in a dining room or similar area.”
Employees at Changing Options told a state licensing program analyst during a surprise visit in late May that this never even happened.
The regulator concluded the allegation was unsubstantiated.
However, Team 10’s investigation into the matter prompted the state Department of Social Services to take a second look after officials were asked if they had the same emails given to the station.
The state then reopened its investigation in June.
It then gave the company a health and safety citation for deficiencies and put Changing Options on a plan of correction.
State records do not specifically say why Changing Options was cited, but a records clerk for the state told Team 10 it had to do with the January incident.
The owner of Changing Options, eight current and former staff members and its attorney declined to be interviewed. One high-ranking employee said the event never happened.
Matthew Wallin, an attorney for Changing Options, told Team 10 to stop contacting company employees.
“Changing Options operates its facilities in conformity with its licenses in compliance with applicable state and federal laws,” Wallin wrote to Team 10. “Changing Options has no comment with regard to any of your inquiries at this time.”
Company Values
Changing Options is in a residential area in northeast Ramona with a cluster of homes that serves up to 35 people.
It was established in 1987, and the company says its mission is to “provide community based mental health treatment for adults with serious mental disorders.”
The company’s website said its values are integrity, respect, compassion, commitment and teamwork.
Those who live at Changing Options may have schizophrenia, bipolar disorders, substance abuse issues or other mental disorders, according to the facility’s website.
Changing Options also accepts those through a court order or conservator.
Those under the care of San Diego County’s Office of Public Conservator are adults who are gravely disabled. That means they are unable or unwilling to provide for basic, food, shelter and clothing needs for themselves.
A behavioral health coordinator for that office said the agency could not comment about the patients under its care at Changing Options because of privacy issues.
One father told Team 10 that his adult daughter has lived there for six years, and he was happy with the services, which he said can cost at least $6,000 a month.
State investigation
The California Department of Social Services, which regulates facilities like Changing Options, received a complaint about the January incident on April 10, records show.
The complaint also claimed Changing Options was inadequately staffed and wasn’t addressing a pest infestation.
Team 10, less than a week later, interviewed the whistleblower who filed that complaint with state regulators.
As Team 10 was reporting on Changing Options and asking state officials about the facility, the state on May 22 conducted an unannounced inspection at the 35-person group home in East County.
According to a state report, Changing Options staff members told a state regulator during that surprise inspection that “no client had ever been forced” to eat meals and receive medication outside.
The reason: “It would have been unethical,” they told regulator Daniel Pena, according to the report.
The report added that former staff were interviewed and denied forcing any client to eat or take medicine outside “due to their refusal to practice sound hygiene.”
The individual who allegedly didn’t shower also told Pena it didn’t happen.
State Report
Pena concluded the allegations were unsubstantiated.
“Department policy does not permit me to speak on official investigations,” he told Team 10.
New Investigation
Team 10 on June 10 then asked the state about internal emails the station had received about the alleged event and provided those documents to regulators seeking comment.
The state the next day reopened an investigation into Changing Options.
Theresa Mier, a state spokeswoman, told Team 10 the agency “cannot comment on ongoing investigations.”
The state on June 19 then conducted another unannounced visit to Changing Options.
The company was put on a plan of correction because of “deficiencies” and given a Type B Citation.
That’s a violation, if not corrected, may be an immediate risk to the health, safety or personal rights of the clients.
Citation
The state has declined to release its amended investigative report despite numerous requests for it by Team 10. A state official told Team 10 the citation was from the January incident.
State officials have declined to comment.
‘Wasn’t the right thing to do’
Albert Maurice Trammel is a decorated Army veteran with a background in police work.
He began working at Changing Options a year ago to care for the residents.
Trammel, who at 6-foot-3 also goes by Big Mo, said he’s loved caring for them. He also acknowledged that he’s been disciplined by the company and accidentally gave the medication to a client.
He said he was especially troubled by the Jan. 6 incident that he said involved a resident who had schizophrenia.
He said he came to Team 10 and filed a complaint with the state because managers at the facility ignored his concerns.
“It was freezing in Ramona during that time,” said Trammel of the alleged January incident.
Trammel said residents have breakfast around 8 a.m., lunch around noon and dinner around 6 p.m.
National Weather Service records show that in Ramona on Jan.6, it was 36 degrees just before breakfast, 64 degrees around lunch and 46 degrees right before dinner.
“It wasn’t the right thing to do,” said Trammel, who added it happened for several days. The emails show one of the people on the chain was a senior-level employee.
Team 10’s findings
Along with the January incident, a Team 10 investigation based on state records, internal Changing Options emails and an interview with Trammel found that during the past year, Changing Options has:
- Been placed on a state plan of correction after a client with bipolar disorder grabbed and ingested a cup of pills that belonged to another resident.
- Warned staff about a different incident regarding significant errors in distributing medications to residents.
- Left knives and scissors out in the open.
- Had a resident walk away from a group dinner outing in Ramona and then walk nearly two miles in the dark and light rain by himself back to Changing Options.
“When they send their loved ones there, they expect a certain amount of care,” said Trammel. “You don’t expect for your loved one to be left out in the cold or you don’t expect for your loved one to be left unsupervised at a restaurant or have knives laying around or some of the other various things that were happening.”
Medication errors
The latest state investigation comes roughly a year after Changing Options came under state scrutiny for self-reporting that a client had grabbed and ingested a cup of medication that belonged to another person.
State regulators at that time found medication at Changing Options was not stored in a safe and locked place and posed a potential safety risk.
Trammel said he also has made medication errors, and he received a written reprimand in April for a HIPPA violation related to looking at or sending internal emails.
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects sensitive health information from being disclosed without the patient’s consent or knowledge.
“When I gave out the wrong medication to a client, you know, I admitted it… When I saw the write up, I said 'Oh, am I being written up for giving out the wrong medication?'” Trammel said. “As you can imagine, the amount of pills and medication we have that's being dispensed at that location is staggering, to say the least.”
Trammel noted on Nov. 17, 2023, an all-staff email was sent with the subject line: Medication errors.
“It has been brought to my attention that there have been some significant medication errors this past week,” the company email said. “This is a reminder to always put everything else aside when you are doing medications.”
The memo noted that there was a conversation with a parent whose child was on the receiving end of the medication errors.
A state spokeswoman said regulators were unaware of that email.
Client walking away
Two days before that email was sent, Changing Options had a resident walk away from a dinner outing, records show.
Trammel said one of his duties included driving clients to a local restaurant each week, and he had done this at least 17 times since starting there in July 2023.
He said the residents looked forward to the outing, but nearly every week there were disputes among them on where to eat.
Trammel said he was told to always take them to the same restaurant and to not leave them alone.
However, he said that didn’t happen on Nov. 17, one of the days Trammel didn’t drive, according to a Changing Options email.
An internal email shows two residents were taken to a Rubio’s restaurant in Ramona, while the others and a Changing Options staff member went to a Wendy’s about 150 yards away.
The two residents at Rubio’s had done “independent walks” in the past, but they were told “to not go anywhere else” according to a staff email. It also said both understood the directives.
In the dark and rain
But when the staff member went to retrieve the two at Rubio’s, one resident walked away – in the dark and in the rain.
The staff person wrote she looked numerous times in the parking lot as well as a convenience store and all along Main Street but had “no luck.”
The Nov. 15, 2023, email sent at 10:10 p.m. to the entire staff showed the client eventually walked back to Changing Options, about 2 miles from the restaurants.
The email said the client was questioned about his whereabouts when he returned.
“He doesn’t take responsibility for some of his actions,” the staff member who left the person wrote in the e-mail obtained by Team 10. “He was angry and yelling like he has done in the past. He also threatened to call 911.”
Trammel said he was stunned his colleague took the clients to two different restaurants.
“When they go out, they are in your care. It’s an outing. A supervised outing and you’re not to let anyone out of your sight,” Trammel said.
Trammel said there’s a great risk to the resident and the community when someone from Changing Options is not supervised.
“They can’t delineate most of the time where they are. The reality. And, hence, them walking off. There is a risk of them getting hit by a car,” he said. “Or other people approaching them and that’s not the way outings are typically ran.”
