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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608677
Report Date: 08/15/2024
Date Signed: 08/15/2024 03:28:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2024 and conducted by Evaluator Raymond Comer
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240805152114
FACILITY NAME:AMBITIONS - VERDUGO 1FACILITY NUMBER:
197608677
ADMINISTRATOR:JESUS SANTANAFACILITY TYPE:
735
ADDRESS:2814 W VERDUGO AVETELEPHONE:
(818) 562-7246
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:4CENSUS: 4DATE:
08/15/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nichelle MathisTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff engaged in a physical altercation with resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, (LPA) Raymond Comer, arrived at 10:00 am and met facility staff. (S1)
S1called Administrator, Nichelle Mathis, and the reason for visit was disclosed.

A physical plant tour of the facility was conducted. No health and safety issues were observed. At 10:40 am, LPA initiated interviews with Administrator, and Staff.

Allegation: Staff engaged in a physical altercation with a resident in care.

Staff (S3) is the Reporting Party. S3 states observing another staff (S4) hitting resident (R1) and, on a separate occasion, pushing R1 down in the restroom. Interviews with staff indicate they have not witnessed S4, nor other Staff, hitting any residents in the facility. No witnesses were present to observe the incident.

[continued on LIC 9099C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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 31-AS-20240805152114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: AMBITIONS - VERDUGO 1
FACILITY NUMBER: 197608677
VISIT DATE: 08/15/2024
NARRATIVE
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At the time of LPA visit to the facility, (2) out of (4) residents were interviewed. Residents who were able to communicate state that they are respected by staff, and have not been hit, or abused in any way by staff, nor other residents. Residents interviewed say they have not heard, nor witnessed, anyone abused by staff.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violation did, or did not occur. Based on LPA's observations, and interviews, the allegation is
UNSUBSTANTIATED.

An Exit interview was conducted, and report was provided to the Administrator.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2