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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602199
Report Date: 03/29/2022
Date Signed: 04/27/2022 10:31:56 AM

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 DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/23/2021 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20211223104633
FACILITY NAME:AMBITIONS - CARSON DAY PROGRAMFACILITY NUMBER:
198602199
ADMINISTRATOR:JUAN AMBROSEFACILITY TYPE:
775
ADDRESS:329 W TORRANCE BLVDTELEPHONE:
(310) 715-1796
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:60CENSUS: 0DATE:
03/29/2022
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:ADMINISTRATOR JUAN AMBROSETIME COMPLETED:
01:45 PM
ALLEGATION(S):
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MASK ARE NOT BEING WORN BY CLIENTS
INVESTIGATION FINDINGS:
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On 03/29/2022 around 12:00pm Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Today’s complaint investigation was conducted face to face with Administrator Juan Ambrose

The investigation revealed the following:

Allegation: Mask are not being worn by clients.
It is alleged that the” facility clients are not wearing masks”. On 12/30/2021 LPA Calderon interviewed S1-S7 who all stated that they are required to wear mask while inside the facility and clients are also required to wear mask inside the facility. On 12/23/2021 LPA Calderon interviewed witness who stated that staff and clients do not wear masks and that there are positive covid 19 clients that come to the facility. On 03/29/2022 LPA Calderon reviewed the mitigation plan and toured the facility. LPA Calderon observed that all staff wear masks and there is one way into the facility. LPA Calderon observed that staff checked the temperature of LPA and had LPA sign in which follows the mitigation plan. On 03/29/2022 LPA Calderon interviewed C1 -C7 all state that the facility requires them to wear a mask and all staff wear masks while inside the building. Clients do not know of any client or staff that tested positive for Covid 19.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
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 11-AS-20211223104633
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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: AMBITIONS - CARSON DAY PROGRAM
FACILITY NUMBER: 198602199
VISIT DATE: 03/29/2022
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

A telephonic exit interview was conducted with Administrator Juan Ambrose, and a hard copy was provided for records




SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2