198602113-12-12-2024-28-AS-KRAZ-DBVRTK-20241212121825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602113
Report Date: 12/12/2024
Date Signed: 12/12/2024 12:18:34 PM

Document Has Been Signed on 12/12/2024 12:18 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	AMBITIONS - HEDDA STREET		FACILITY NUMBER:	198602113
ADMINISTRATOR/ DIRECTOR:	LAQUALA MCKINLEY		FACILITY TYPE:	735
ADDRESS:	12914 HEDDA STREET		TELEPHONE:	(562) 474-8418
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY: 3	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	12/12/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:26 AM
MET WITH:	Renee Davenport		TIME VISIT/ INSPECTION COMPLETED:	12:10 PM

NARRATIVE

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted a Case Management Visit-Incident on 12/12/2024, stemming from Unusual Incident/Injury Report dated 11/26/2024. LPA was greeted by Direct Support Staff (S1) and explained the purpose of the visit. Program Manager- Renee Davenport arrived shortly after to assist.

Case Management-Incident findings:

On11/18/2024, around 11:30pm staff#2 (S2) called Administrator Jassmond Johnson and informed her that staff#3 (S3) had not yet arrived to relive S2 from their shift and S2 had another job they needed to be at. Administrator Johnson informed S2 to wait for S3 to arrive and under no circumstances, should S2 leave the clients unattended. Administrator Johnson called S3 and S3 informed Administrator Johnson that they were running late and would arrive to the facility soon. At 11:42pm, S3 called Administrator Johnson and informed her that S2 was not at the facility when S3 arrived, and the clients were left unsupervised.

According to Administrator Johnson, S2 was immediately suspended, pending an investigation. On 11/25/2024, S2 was terminated from the facility. On 12/04/2024, all staff received in house training on client supervision.

Per Title 22, Division 6, Chapter 1 Article 6. Continuing Requirements- 80078(a) Responsibility for providing Care and Supervision- The licensee shall provide care and supervision as necessary to meet the client’s needs.

Based on records reviewed and interviews conducted during visit, on 11/18/24, facility staff left three (3) out of the three (3) clients unsupervised. LPA Ramirez will issue one (1) deficiency and assess a civil penalty in the amount of $500 dollars. Exit interview was conducted and a copy of this report, LIC 421IM, and appeals rights was provided.

Tony Vasallo	TELEPHONE: (323) 981-3977
Kimberly Ramirez	TELEPHONE: (323) 981-3970
	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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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Document Has Been Signed on 12/12/2024 12:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: AMBITIONS - HEDDA STREET	FACILITY NUMBER: 198602113
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

(a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by: Staff left 3 out of 3 clients unsupervised for 11 minutes on 11/18/24.
	Deficient Practice Statement
1 2 3 4
	POC Due Date: 12/19/2024
	Plan of Correction
1 2 3 4	Licensee will certify a plan to address how the facility plans to address unexpected staffing shortages. Plan must be emailed to LPA Ramirez by 12/19/24.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Tony Vasallo	TELEPHONE: (323) 981-3977
Kimberly Ramirez	TELEPHONE: (323) 981-3970
	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

LIC809 (FAS) - (06/04)

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