198601561-5-21-2024-28-AS-RORN-D5WL4P-20240604082553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601561
Report Date: 05/21/2024
Date Signed: 05/21/2024 03:52:18 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/24/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230724084312

FACILITY NAME:	AMBIRIA HOMES I		FACILITY NUMBER:	198601561
ADMINISTRATOR:	CARMEN VARGAS		FACILITY TYPE:	735
ADDRESS:	6424 SHERMAN WAY		TELEPHONE:	(323) 771-6800
CITY:	BELL	STATE: CA	ZIP CODE:	90201
CAPACITY:	4	CENSUS: 3	DATE:	05/21/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	House Manager Horace Evans		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility does not have an adequate amount of food for residents in care.
Staff are not allowing residents to leave the facility.
Uncleared adult.
Staff do not ensure that residents are provided with activities.
Staff do not ensure that residents have access to telephones in order to make and receive confidential calls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made a subsequent visit to the facility and was greeted by House Manager Horace Evans and explained the reason for the visit.
The purpose of the visit is a subsequent visit to deliver findings from the complaint dated 07/24/2023.
The initial visit was conducted on 08/03/2023 and included the following:
Staff and client roster were submitted.
LPA Gonzalez collected copies of facility menu and activity menu. LPA also conducted a tour of facility which included observations of facility kitchen, common areas, dining room and garage. LPA observed an ample amount of food at the time of the visit. There was enough food for 7 days non perishables and 2 day perishables. LPA additionally observed additional supply of food in the facility garage.
A subsequent visit was completed on 11/28/2023 and included the following:
LPA collected copies of resident and staff roster. LPA also conducted a tour of facility which included observations of facility kitchen, common areas, dining room and garage. LPA observed enough food for 7 days non perishables and 2 day perishables. There was also an additional supply of food in the garage.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

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 3

Control Number 28-AS-20230724084312

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 I	FACILITY NUMBER: 198601561
	VISIT DATE: 05/21/2024

NARRATIVE

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At visit at 9:45 AM House Manager Horace Evans was interviewed via telephone.
At visit at 10:15 AM Staff Mary Bowleg was interviewed.
At today's visit 05/21/2024 Client's C1 and C2 were interviewed at 1:45 PM.
Staff S1 and Administrator were interviewed at 2:45 PM.
In regards to the allegation Facility does not have an adequate amount of food for residents in care, based on interviews conducted, information gathered and tour of the facility it was revealed on 3 visits dated 08/03/2023, 11/28/2023, and today's visit 05/21/2024 that there was enough food for 7 days non perishables and 2 day perishables. LPA additionally observed additional supply of food in the facility garage.
Interviews with Client's C1 and C2 who stated that there is more than enough food and you are able to get 2nds.
Interview with Administrator who stated that they are always overstocked and they have 14 days supply and they go shopping every Tuesday.
Staff interviewed stated that freezers are packed and there is enough food. Also clients can get what they want when they want.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the complaint investigation of the allegation is unsubstantiated.
In regards to the allegation Staff are not allowing residents to leave the facility, based on interviews conducted and information gathered it was revealed by C1 and C2 that all clients are able to leave and no one stops them.
Also staff will take them to the store for food and drinks.
Interview with staff who stated they are allowed to leave and no one stops them. Will take walks to the park and also take clients to the store.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the complaint investigation of the allegation is unsubstantiated.
In regards to the allegation Uncleared adult. based on interviews conducted and information gathered it was revealed in review of Staff Roster LIC 500 and staff who have eligible clearance specified on Guardian that all staff were cleared and there was not an uncleared adult.
Clearances were verified on 11/28/2023, 04/11/2024 and today 05/21/2024.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the complaint investigation of the allegation is unsubstantiated.
In regards to the allegation Staff do not ensure that residents are provided with activities, based on interviews

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20230724084312

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 I	FACILITY NUMBER: 198601561
	VISIT DATE: 05/21/2024

NARRATIVE

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it was revealed by Client's C1 and C2 that they play Connect 4, will do dancing and puzzles. Will also draw.
Also will go to on outings to the park and swimming.
Staff interviewed stated that they do board games and arts and crafts.
Also will go on outings to the salon and park.
Stated they will play songs and dance with the clients.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the complaint investigation of the allegation is unsubstantiated.
In regards to the allegation Staff do not ensure that residents have access to telephones in order to make and receive confidential calls, based on interviews conducted and information gathered Client's C1 and C2 stated they are able to use the phone everyday.
C1 stated that she is always on the couch and sees the other 2 clients always using the office phone.
C2 stated she calls her mom sometimes from the office phone and stated that everyone is allowed to use the phone.
Interview with staff who stated that the office phone can be used anytime they want.
Stated that 2 clients are on the phone all the time calling their mom and almost everyday.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the complaint investigation of the allegation is unsubstantiated.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

LIC9099 (FAS) - (06/04)

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