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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608677
Report Date: 11/08/2024
Date Signed: 11/08/2024 02:08:05 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
04/30/2024 and conducted by Evaluator Antonia Alvizar-Ettima
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240430160919
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: 3DATE:
11/08/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Zuleyma Osorio, Day Program ManagerTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained multiple unexplained injuries while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Antonia Alvizar-Ettima made an unannounced subsequent visit to the facility to deliver finding for the above noted allegation at approximately 12:30PM. LPA Alvizar-Ettima met with Day Program Manager and disclosed the purpose of the visit.

On 04/30/2024, Community Care Licensing Department (CCLD) received a complaint alleging that resident sustained multiple unexplained injuries while in care facility staff neglected and/or failed to provide an adequate level of care to the resident #1 (R1) resulting in R1 sustaining bruising and rib fracture.

The allegation was referred to Community Care Licensing Departments (CCLD) Investigation Bureau (IB) and the investigation was assigned to Senior Investigator (SI) Laura Garcia. Initial visit was conducted on 05/02/2024 by LPA Antonia Alvizar-Ettima. During initial visit, at 9:50AM, physical plant inspection was made to ensure that there are no immediate health and safety hazard affecting
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
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-20240430160919
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: 11/08/2024
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
residents. At approximately 10:00AM LPA requested and received copies of resident (R1’s) ID/Emergency, Admission Agreement, Physician Report, Medication Administration Records, Unusual Incident Reports, Client Progress Notes, Client Behavior Notes, Quarter Program Review, Staff schedule and contacted information.

Investigation was continued by SI Garcia. Interviews of the staff conducted by SI on May 14, 2024, and June 04, 2024 revealed they denied the allegation. On 09/316/24 SI spoke with witness (W1) who had knowledge about R1’s health care. W1 denied the allegation and indicated that had no concerns or issues with the level of care facility staff provide to R1. SI was not able to interview R1 due to being non-verbal. A review of R1’s record conducted on 11/06/24 did not revealed any information to support the allegation.

Overall investigation did not provide sufficient information and/or evidence to substantiated neglect/lack of care. Therefore, based on observation, interviews and record review, the allegation is UNSUBSTANTIATED at this time.

No Deficiencies noted at time of visit.

Exit interview was conducted and a copy of report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2