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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602113
Report Date: 02/23/2023
Date Signed: 02/24/2023 10:48:00 AM

Substantiated


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
01/07/2021 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210107151120
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:
02/23/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Baltazar CornejoTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are refusing to meet resident's care needs
INVESTIGATION FINDINGS:
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This is an amended report, to previous report dated 4/6/21, with corrections to 9099 and 9099-D.

Licensing Program Analyst (LPA) Angelica Rea conducted another complaint visit for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator, Laquala McKinley.

Regarding the allegation that staff are refusing to meet resident's care needs, the investigation consisted of Interview(s) with Administrator, and Staff #2. Administrator stated that Staff #1 left client #1 and client #2 unsupervised on 1/5/21. Administrator stated that Staff #1 was instructed to stay with the clients until Administrator arrived, but Staff #1 left the facility, and there was no other staff present at the time. When Administrator arrived at the facility, Client #1 and Client #2 were unsupervised. Adminstrator stated that Staff #1 has not returned to work since that day.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
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-20210107151120
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: 02/23/2023
NARRATIVE
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Staff #2 stated that she worked with Staff #1 on one occasion and Staff #1 refused to assist with the resident(s). Staff #2 stated that she provided a written statement to Administrator which detailed her experience working with Staff #1. LPA was unable to interview Staff #1. Client #1 and Client #2 are non-verbal, therefore LPA was unable to interview them.

Based on LPA's observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

An immediate Civil Penalty will be assessed in the amount of $500.

Exit interview conducted with Administrator. Copy of report, and Appeal Rights provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 28-AS-20210107151120
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/24/2023
Section Cited
CCR
80078(a)
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The licensee shall provide care and supervision as necessary to meet the client's needs.

This was not met as evidenced by: Staff #1 left Client #1 and Client #2 unsupervised on 1/5/21. Client #2 was also left in a soiled diaper for an extended period of time. This posess a potential health and safety risk for the clients receiving care and supervision in the facility.
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Administrator will ensure that all staff are trained on the responsibility of providing care and supervision. Administrator will conduct an in service with all staff, and will provide proof of training to LPA Rea by POC due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3