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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602219
Report Date: 12/14/2021
Date Signed: 12/14/2021 02:58:15 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
12/06/2021 and conducted by Evaluator Nina Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211206142321
FACILITY NAME:AMBITIONS - 183RD STREETFACILITY NUMBER:
198602219
ADMINISTRATOR:LESLYN VENEGASFACILITY TYPE:
735
ADDRESS:11417 183RD STTELEPHONE:
(562) 219-5799
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY:3CENSUS: 1DATE:
12/14/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Maria JimenezTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff hit clients.
Staff shove clients.
Staff are taking advantage of clients.
Staff barricade clients in room.
INVESTIGATION FINDINGS:
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12/14/2021 Licensing Program Analyst (LPA) Nina Galarza conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with staff Jericka Miller and stated the purpose of the visit. LPA later me with administrator, Maria Jimenez and stated the purpose of the visit.

The investigation consisted of interviews with Administrator and Staff #1- (S1-S7). LPA was unable to interview clients due to communication barriers. LPA requested documents; staff and client roster, C1 and C2's Face Sheet, C1 and C2 Physician's Report, C1 and C2 Admissions Agreement, C1 and C2 Independent Progress Plan, C1 and C2 Medication Sheet for October and November 2021 , C1 and C2 Personal and Incidental Sheet for October and November 2021, Staff training history, Staff training material on behavior intervention. LPA reviewed on the job training history and training materials on behavior intervention and client rights for S1-S5. LPA also contacted Harbor Regional Center facility's representative. 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: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
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-20211206142321
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 - 183RD STREET
FACILITY NUMBER: 198602219
VISIT DATE: 12/14/2021
NARRATIVE
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The investigation revealed the following: Regarding allegation(s): Staff hit clients, staff shoves clients, staff take advantage of clients, staff barricade clients in room. It is alleged staff would “push, shoves, yell, and barricade client(s) in their room. LPA was unable to interview clients due to communication barriers. During interview with Administrator, the administrator denied all allegations. During interviews with staff, (7) out of (7) staff interviewed denied the allegations. (7) out of (7) stated to have good relationships with clients and (7) out of (7) stated Staff are knowledgeable of client's personal rights. Administrator stated that no client or staff have reported to have heard or observed any of those behaviors towards the clients and that would not be tolerable.

Although the allegation may have happened or is 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 held. A copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nina Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2