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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608610
Report Date: 10/29/2021
Date Signed: 10/29/2021 02:21:09 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/25/2021 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20211025121237
FACILITY NAME:AMBITIONS - VERDUGO HOUSE 2FACILITY NUMBER:
197608610
ADMINISTRATOR:LUCY KECHEDJIANFACILITY TYPE:
735
ADDRESS:3206 W VERDUGO BLVDTELEPHONE:
(818) 562-7794
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:4CENSUS: 4DATE:
10/29/2021
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Monique Tate, AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff hit resident.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Tao, conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Administrator, Monique Tate. LPA explained the purpose of today’s visit is to discuss the above mentioned allegation.

The investigation consisted of interviews with Client #1 through Client #4; Administrator, Staff#2 through Staff#6; reviewed Client #2 file and Staff in-service training. A copy of Staff in-service training obtained.

In regards to the allegation: Staff hit resident.
During today's visit, LPA interviewed staff and clients. Interviews of Clients and Staff revealed that Administrator and staff did not hit client. Three (3) out of four (4) clients was non-verbal and unable to answer questions. One (1) out of four (4) clients denied staff hit client. Five (5) out of six (6) staff denied staff hit client. One (1) of six (6) staff said staff was holding a wooden spoon when preparing dinner and talking to client but staff did not hit client. No evidence staff was threatening client. The investigation revealed that Staff did not hit client. (-Continued in LIC 9099 c- )
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
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 2
Control Number 28-AS-20211025121237
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: AMBITIONS - VERDUGO HOUSE 2
FACILITY NUMBER: 197608610
VISIT DATE: 10/29/2021
NARRATIVE
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Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Administrator. A hard copy of the report and appeal rights were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2