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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602113
Report Date: 01/13/2022
Date Signed: 01/13/2022 12:02:50 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
01/04/2022 and conducted by Evaluator Nina Galarza
COMPLAINT CONTROL NUMBER: 28-AS-20220104112031
FACILITY NAME:AMBITIONS - HEDDA STREETFACILITY NUMBER:
198602113
ADMINISTRATOR:LAQUALA MCKINLEYFACILITY TYPE:
735
ADDRESS:12914 HEDDA STREETTELEPHONE:
(562) 474-8418
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:3CENSUS: 3DATE:
01/13/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Baltazar CornejoTIME COMPLETED:
12:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have adequate food supplies on hand.
Food served to clients is not of the quantity to meet their needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
1/13/2022 Licensing Program Analyst (LPA) Nina Galarza conducted an unannounced initial complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator, Baltazar Cornejo and stated the purpose of the visit.

The investigation consisted of: interviews with Administrator and S1. LPA was unable to interview Clients #1-3 (C1-C3) due to communication barriers.

LPA toured facility kitchen and food supply with Administrator. LPA observed 2 days perishable and 7 day non-perishable food for all clients. LPA also observed emergency food and water supply.

CONTINUED 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nina Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
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 2
Control Number 28-AS-20220104112031
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: AMBITIONS - HEDDA STREET
FACILITY NUMBER: 198602113
VISIT DATE: 01/13/2022
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
The following documents were provided to LPA Nina Galarza on 1/13/2022; staff roster, client roster, admission agreement for C1-C3, needs and services plan for C1-C3, weekly grocery list and food menu.

The investigation revealed of the following: Allegation #1: "Facility does not have adequate food on hand." On 1/13/2022 LPA toured kitchen and food supply with Administrator. During the tour, LPA observed 2 days perishable and 7 day non-perishable food for all clients. On 1/13/2022 LPA interviewed Administrator and S1. (2) out of (2) staff denied allegation and stated that clients are always given meals and snacks.

The investigation revealed of the following: Allegation #2 "Food served to clients is not of the quantity to meet their needs." On 1/13/2022 LPA interviewed Administrator and S1. (2) out of (2) staff denied the allegation and stated that a Nutritionist plans all meals for clients. (2) out of (2) staff stated clients are regularly given snacks throughout the day in between meals. On 1/13/2022 LPA observed lunch service. During lunch service, LPA observed clients are given food recommended by Nutritionist.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report and appeal rights given to Baltazar Cornejo
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nina Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2