<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608472
Report Date: 08/01/2024
Date Signed: 08/01/2024 06:30:06 PM

Document Has Been Signed on 08/01/2024 06:30 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:AMBITIONS - ROSE HOUSEFACILITY NUMBER:
197608472
ADMINISTRATOR/
DIRECTOR:		MONIQUE TATEFACILITY TYPE:
735
ADDRESS:1132 N ROSE STTELEPHONE:
(310) 817-6100
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 3CENSUS: 3DATE:
08/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Bianca Esparza - AdministratorTIME VISIT/
INSPECTION COMPLETED:
06:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An unannounced Required One (1) year visit was conducted on this day by Licensing Program Analyst (LPA) Gary Tan. LPA met with Administrator Bianca Esperza and explained the purpose of the visit is stated. This is a Lanterman Regional Center vendored facility Specialized Level.

LPA conducted physical plant tour inside and out at 3:28 PM. During the tour, LPA observed that the facility has three (3) bedrooms and two (2) bathrooms. There is no body of water in the facility. The facility is fire cleared for three (3) non-ambulatory residents.

The front door is the main entrance being utilized at the facility. Sign in sheet and screening station is located immediately upon entrance. Hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection Plan.

All trash cans were observed to be with cover. The facility has a designated visitors' area at the side yard. The facility has sufficient stock of PPE in the garage.

Bedrooms were toured and observed to be clean and appropriately furnished.
Bathrooms were observed to be clean, sanitary and with necessary supplies. Hot water temperature was measured at range of 113.6°F to 116.1°F.

Physical plant was checked for cleanliness and condition. Facility was observed to be in good repair and clean during today's visit.

Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMBITIONS - ROSE HOUSE
FACILITY NUMBER: 197608472
VISIT DATE: 08/01/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(continued from LIC 809)

Kitchen area is observed to be clean and sanitary. All disinfectants, cleaning solutions are kept in locked cabinet below the sink. Knives and sharps are locked and secured in the kitchen cabinet.
Food. The facility is observed to have sufficient food supply for clients. Temperature of facility wall thermostat was set at 74.0°F and observed to be within the required range.
Fire extinguishers were observed to be located in the kitchen and bedroom hallway. Extinguishers were observed to be operable and last inspected on 01/12/24. Fire alarms are hardwired and interconnected and observed to be operational. There is a carbon monoxide detector installed in the facility. The facility is equipped with sprinkler system.
Medications were observed to be locked, inaccessible and stored in the office in between the living room and bedroom adjacent to the kitchen. There was a complete first aid kit located in the medication cabinet.
Garage is attached to the house and currently being used as PPE, emergency food and tools and other toxins and cleaning agents’ storage. Laundry area is located inside the garage. Laundry detergents and other cleaning agent are kept in the locked cabinet on top of the washing and machine. The garage was observed to be locked during visit.

Client records. Three (3) client records were reviewed. Clients’ record appeared to be complete and current. Staff records were also reviewed. Three (3) staff records were reviewed, they all have criminal record clearances and associated to this facility. Current training and first aid observed for staff on duty. Administrator's certificate was observed to be current.

Disaster drill was last conducted on 06/17/24. Required posting observed in facility (complaint hot line poster, personal rights, etc).

There was no health and safety hazard observed during the day of inspection.

Exit interview conducted and a copy of this report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2