197608761-1-7-2025-31-AS-NMAN-DDCUX5-20250128145746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608761
Report Date: 01/07/2025
Date Signed: 01/07/2025 04:51:00 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
02/22/2024 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240222132032

FACILITY NAME:	AMBITIONS - ROSE 2		FACILITY NUMBER:	197608761
ADMINISTRATOR:	MONIQUE TATE		FACILITY TYPE:	735
ADDRESS:	2100 N ROSE ST		TELEPHONE:	(818) 561-4014
CITY:	BURBANK	STATE: CA	ZIP CODE:	91505
CAPACITY:	4	CENSUS: 2	DATE:	01/07/2025
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Program Manager, Leticia Woods & Direct Support Professional (DSP) Celeste Brown		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff physically attacked the client in care
Staff verbally abused client in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Antonia Alvizar-Ettima made an unannounced subsequent visit to the facility to investigate and deliver finding for the above noted allegations at approximately 10:15a.m., LPA Alvizar-Ettima met with Program Manager, Direct Support Professional (DSP) and disclosed the purpose of the visit.

An initial complaint visit conducted on 02/29/2024 at 10:30 a.m. LPA Alvizar-Ettima and DSP, Brown conducted physical plant tour. Between 10:30a.m. – 11:20a.m. LPA conducted interviews with client C#1, Program Manager, Day Program Manager, and staff S#2. LPA Alvizar- Ettima asked questions relevant to the nature of the complaint. At 11:25a.m. LPA Alvizar-Ettima requested the staff roster, staff schedule, staff contact information, clients’ roster, client #1 (C1s) Identification and Emergency Information, Physician Report, Preplacement Appraisal Information, Needs & Services Plan, IPP, ISP, and Internal Log Notes.

Prior to this visit on 01/06/2025 LPA Antonia Alvizar-Ettima reviewed the information and the documents
Cont. LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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 3

Control Number 31-AS-20240222132032

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 - ROSE 2	FACILITY NUMBER: 197608761
	VISIT DATE: 01/07/2025

NARRATIVE

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previously obtained from the facility. At the time of this visit at approximately 10:40a.m., Program Manager and LPA conducted a physical plant tour. At about 11:00am., LPA interview two (02) out of two (02) clients. LPA also interviewed via-phone staff #1 (S1) and another staff that was present at the time of the incident.
1.) Staff physically attacked the client in care.

It was alleged that Staff #1 (S1) hit client #1 (C1) with a broom on the arm. LPA interview with Program Manager and three (03) staff reveal that C1 has behavior episodes and becomes physically aggressive towards staff and clients. C1 has a history of fabricating stories. During interviews, S1 denied hitting C1 or any other client in care. S1 revealed that while they were giving C1 an afternoon snack of grapes in a cup, C1 refused and wanted to eat the grapes directly from the container not from the cup and started exhibiting a behavior. C1 attempted to hit S1, other staff and clients with a broom. Staff revealed they firmly told C1 not to hit them and attempted to redirect. Interview with C1 revealed that they were attacked by staff. However, they were unable to describe the details of the incident. LPA observed C1 and did not notice any bruising or marks on C1. Two (02) out of two (02) clients reveal staff has not hit them. Two (02) out of two (02) clients reveal C1 has tried to hit them, and staff intervened.

A review of the Departments internal files shows that there are incident reports involving C1 being physically and/or verbally aggressive toward staff. C1 physician report indicated health conditions that may trigger behaviors. Records revealed that staff was following C1”s behavioral support plan to redirect them during challenging behavior episodes; such as emotional outbursts, physical aggression, verbal aggression, and property damage.

Based on interviews, record review, and LPA observation although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

2.) Staff verbally abuse clients in care.

It was alleged that Staff #1 (S1) verbally abuse client #1 (C1) and called C1 names such as “the b word” and “mother…F..er”. During interviews, LPA interview with Program Manager and three (03) staff reveal that

Cont. LIC 9099-C

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240222132032

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 - ROSE 2	FACILITY NUMBER: 197608761
	VISIT DATE: 01/07/2025

NARRATIVE

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C1 has behavior episodes and becomes verbally aggressive towards staff and clients. S1 denied calling C1 any of those names. S1 revealed that they do not call C1 or any clients in care those names. S1 revealed that when C1 was having a behavior episode they were shouting, screaming “the B word” and “F” words to everyone in the home. S1 revealed C1 has a history of verbal aggression and outbursts. S1 revealed they receive a training and try to follow specific instructions to redirect C1 when they become verbally abusive. Interview with C1 revealed that they were verbally abused by staff. However, they were unable to describe the details of the incident. Two (02) out of two (02) clients reveal staff does not verbally abuse them. Two (02) out of two (02) clients reveal C1 always says the “the b word” and “mother...F..er” to them, and staff intervened. During the visit LPA did not observe staff verbally abusing clients in care.

Based on interviews, record review, and LPA observation although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety hazard noted during this visit.

Exit interview conducted and a copy of the report was provided. Program Manager granted authorization to DSP, Brown to sign the report because she had attend a meeting away from this facility.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC9099 (FAS) - (06/04)

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