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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601000
Report Date: 08/08/2024
Date Signed: 08/08/2024 05:07:04 PM

Document Has Been Signed on 08/08/2024 05:07 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:AMBITIONS - 184TH STREETFACILITY NUMBER:
198601000
ADMINISTRATOR/
DIRECTOR:		WALKER, DEMETRAFACILITY TYPE:
735
ADDRESS:4025 W 184TH STTELEPHONE:
(424) 329-3052
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 4CENSUS: 4DATE:
08/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Demetra WalkerTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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
On 08/08/24, Licensing Program Analysts (LPA), Wendy Gibbs and Deborah Lee, conducted an unannounced annual visit to the facility listed above using the full cares tool. LPAs met with Administrator, Demetra Walker, and the purpose of today’s visit was explained. The facility is licensed to serve four (4) developmentally disabled ambulatory only adults ages 18-59. Clients are Harbor Regional Center.
Physical Plant/Structure The facility is a single-story home in a residential neighborhood. The home consists of four (4) Client bedrooms, two (2) bathrooms, living area, staff work area, dining area, kitchen, laundry area, indoor and outdoor activity area. Outside LPAs observed a covered patio area with table and chairs. All walkways around the home were observed clean, clear, and free of debris, hazards, and obstructions. LPAs did not observe any bodies of water on the premises.
Bedrooms LPAs inspected all client bedrooms and found them to be clean and in good repair. LPAs observed all rooms have the required furniture including a bed, dresser, nightstand, chair, lamp, and storage space for personal belongings. LPAs observed the beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of linens, blankets, and comforters in the cabinet in the hallway.
Bathrooms LPAs observed the bathrooms met Tittle 22 regulations. The bathrooms were observed clean and operational. LPA observed showers had
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: AMBITIONS - 184TH STREET
FACILITY NUMBER: 198601000
VISIT DATE: 08/08/2024
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
nonskid mats, and secured safety handrails. LPA observed an ample supply of towels, hand towels, and wash clothes. LPA observed an ample supply of hygiene products for clients. The water temperature in the bathrooms measured 110.8-degrees and 114.7-degrees Fahrenheit.
Kitchen LPA observed the kitchen to be clean and sanitary. LPA observed appliance to be operable and in good repair. LPA observed an ample supply of cookware, dishware, and cutleries. LPA observed a 2-day supply of perishable foods and a 7-day supply of nonperishable foods, properly stored, labeled, and dated. The water temperature measured 116.0-degrees Fahrenheit. LPAs observed knives and sharps secured in a locked cabinet in the garage and are inaccessible to clients. LPAs observed cleaning supplies secured in a locked cabinet under the kitchen sink and are inaccessible to clients.
Common Rooms LPA observed the facility to be clean and appropriately furnished at the time of visit. The living room has couches and a chair to accommodate all clients. LPAs observed the activity room has two couches to accommodate clients. The dining room has a large table with chairs to accommodate all clients. LPAs observed games and activities in the cabinet in the dining room. All walkways and hallways were observed clean, clear, and free of obstructions and hazards. LPA observed all rooms and hallways has ample lighting. The facility was maintained at a comfortable temperature.
Safety LPA observed smoke detectors and carbon monoxide detectors are operable. LPA observed three (3) fully charged fire extinguishers last serviced on
01/17/24. The last emergency drill was conducted on 08/07/24. The last facility
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

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

DATE: 08/08/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: AMBITIONS - 184TH STREET
FACILITY NUMBER: 198601000
VISIT DATE: 08/08/2024
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
inspection from the Torrance Fire Department was completed on 01/17/24.
LPA observed emergency service numbers posted in the facility. The facility’s Emergency Disaster Plan was observed posted in the facility. All required postings were observed posted in the facility. No firearms or ammunition are stored on the premises.
Files LPAs reviewed the file for four (4) clients and observed they contained the required documents. LPA reviewed the Administrator and three (3) staff files and found they contained the required documents, certification, and training. LPAs observed licensing fees are due, the Administrator stated the main office took care of it.
Medications LPA observed all Centrally Stored Medications secured in a locked closet in the hallway and are inaccessible to clients. LPA observed Centrally stored Medications in their original packaging. LPA reviewed the medications and Medication Administration Records (MAR) for four (4) clients and found they are consistent with properly documented records.
Infection Control During the visit, LPA observed the facility’s infection control practices. LPA observed a sanitizing station and visitor log at the entrance of the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPAs observed required infection control signs posted throughout the facility.
LPAs did not observe or cite any deficiencies.
An exit interview was conducted with Administrator, Demetra Walker, and a copy of this report was provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

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

DATE: 08/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3