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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608761
Report Date: 06/26/2024
Date Signed: 06/26/2024 06:30:36 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, 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
06/20/2024 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20240620111602
FACILITY NAME:AMBITIONS - ROSE 2FACILITY NUMBER:
197608761
ADMINISTRATOR:MONIQUE TATEFACILITY TYPE:
735
ADDRESS:2100 N ROSE STTELEPHONE:
(818) 561-4014
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:4CENSUS: 3DATE:
06/26/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Patricia Valdez, Staff TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff inappropriately touched resident
INVESTIGATION FINDINGS:
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At 10:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Staff #2 (S2), who granted access to the facility. The Administrator was contacted and LPA explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 10:35am, LPA requested client and staff roster. At 10:40am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, relevant to the investigation. At approximately 10:45am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 11:00am – 12:30pm, LPA interviewed the Administrator, Program Manager two (2) staff, and two (2) clients out of three (3) clients.
Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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-20240620111602
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMBITIONS - ROSE 2
FACILITY NUMBER: 197608761
VISIT DATE: 06/26/2024
NARRATIVE
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Allegation: Staff inappropriately touched resident

It was alleged that S1 inappropriately touched C1 while applying a cream to C1’s chest. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that on 06/17/24 the group home staff reported an incident to the facility Program Manager, and an incident report was submitted to the Regional Center (RC) and the Community Care Licensing (CCL). In addition, LPA conducted an interview with the Program Manager and was informed that S1 was hired from RC to provide 1:1 care to C1. Interview with the Program Manager also revealed that C1 liked to watch adult movies and S1 advised C1 that it is very inappropriate and C1 fabricated the above allegation to get rid of S1. Moreover, LPA conducted an interview with two (2) staff and both parties interviewed denied the above allegation and informed LPA that no such approach, other than professional is provided to the clients. Interviews with one (1) out of (2) clients revealed that all staff, including S1, always treat clients with respect. Lastly, LPA conducted an interview with the Regional Center representative and was informed that S1 worked with RC for some time and no such allegation against S1 had been previously filed nor observed. Therefore, based on LPA’s observation, interviews and the information gathered, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2