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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608761
Report Date: 07/13/2023
Date Signed: 07/13/2023 01:05:58 PM

Document Has Been Signed on 07/13/2023 01:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
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: 4DATE:
07/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Antonia Alvizar conducted a Case Management (CM) visit to to the facility to follow up on an Incident Report received regarding Client #1 (C1) and Staff #1 (S1) on or around May 26, 2023. LPA met with staff, Olufunke Oseni and advised her of the visit. Regarding (C1) attacking (S1) during dinner time. The day's visit consisted of interviews, record review and gather documents. LPA has determined that further investigation is needed and will return at a later date.


No health and safety hazard is noted during this visit.
Exit interview conducted, a copy of the report was issued.



SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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