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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601561
Report Date: 03/24/2025
Date Signed: 03/24/2025 11:40:31 AM

Document Has Been Signed on 03/24/2025 11:40 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:AMBIRIA HOMES IFACILITY NUMBER:
198601561
ADMINISTRATOR/
DIRECTOR:
CARMEN VARGASFACILITY TYPE:
735
ADDRESS:6424 SHERMAN WAYTELEPHONE:
(323) 771-6800
CITY:BELLSTATE: CAZIP CODE:
90201
CAPACITY: 4CENSUS: 2DATE:
03/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Staff Adina AgentTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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
Licensing Program Analyst (LPA) Glenn Trueman made a visit to the facility and was greeted by Staff Adina Agent and explained the reason for the visit.
The purpose of the visit is to conduct the required 2025 annual inspection.
Shortly thereafter House Manager Horace Evans arrived.
Currently there are 2 clients.
Annual Inspection includes the following Domains:
Infection Control, Physical Plant and Environmental Safety, Operational Requirements, Staffing, Personnel Records- Training, Client Rights Information, Client rights- Incident Reports, Food Service, Health Related services, Incidental Medical Services, Disaster Preparedness, and Emergency Intervention.
Tour of the facility was conducted and the following was observed:
There are 3 Client Bedrooms which have the required furniture such as bedframes, dressers, lamps and chairs.
Beds have the required linen and the linen is in good condition.
There is 1 Client bathroom. The bathrooms are clean and have the required hygiene items. The hot water temperature was within the required 105 - 120 degrees.
The facility temperature at the time of the visit was comfortable.
There is sufficient lighting throughout the facility. There are smoke detectors located throughout the facility. There is a carbon monoxide detector. The kitchen was inspected. There is sufficient perishable and non-perishable food. The food was also stored properly. Kitchen appliances are clean and are operating properly. The front and backyard are well maintained. There is no pool or other large bodies of water.
1 Staff was interviewed. Clients were all out in the community at Day Program.
2 Client Files were reviewed.
8 Staff Files were reviewed.
Medication was reviewed for 2 Clients and was administered per physician's directions.
No deficiencies.

Exit interview conducted.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2025
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 1