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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602199
Report Date: 07/28/2023
Date Signed: 07/28/2023 08:34:09 PM

Document Has Been Signed on 07/28/2023 08:34 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
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: 26DATE:
07/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Cathy NguyenTIME COMPLETED:
12:59 PM
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On 07/28/23, Licensing Program Analysts (LPAs) Ernand Dabuet and Regina Cloyd conducted an unannounced annual required using the CARE Inspection Tool. LPA met with site manager Cathy Nguyen and explained the purpose of today’s visit. The day program is licensed to operate for sixty (60) ambulatory of which ten (10) may be non-ambulatory ages 18 and over. The consumers are Harbor Regional Center and South Central Los Angeles Regional Center consumers.

The day program is a single-story structure located in a commercial neighborhood. It consists of the following: administrative office, consultation area, conference room, physical activity room, arts and crafts room, controlled multi-sensory stimulation room (SPA), computer lab area, break room/kitchen area, laundry area, music room, salon, and (2) designated restrooms (1) men (1) women restrooms- toilets and sinks are operable. A changing room with a private shower.

LPAs and manager toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected and had adequate lighting furnishings. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 107.2 F. A comfortable temperature of 71 degrees F was maintained.

LPAs observed the day program to be sanitary and appropriately supplied at the time of the visit. Storage rooms for cleaning supplies, and toxins, were stored and not accessible to consumers. The kitchen was inspected and found all appliances in working condition. Fire extinguishers were charged, and smoke detectors and carbon monoxide were operable. The day program has several working landline phones.

Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: AMBITIONS - CARSON DAY PROGRAM
FACILITY NUMBER: 198602199
VISIT DATE: 07/28/2023
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During the visit, LPAs observed the facility's infection control practices. LPAs observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPAs observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

LPAs observed First Aid Kit was maintained. The last fire drill was conducted on 06/30/23. The facility had operational smoke and carbon monoxide. The facility has current liability insurance on file effective 01/01/23 - 01/01/24.

An audit of clients#1-#6 (C1-C6) service files and staff #1-#8 (S1-S8) personnel files revealed to be complete. Interviews were conducted with (3) clients and (3) staff.

No deficiencies during this inspection visit.

An exit interview was conducted with Cathy Nguyen and a copy of the report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC809 (FAS) - (06/04)
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