198602219-10-17-2023-28-AS-LHIS-CWVKQU-20231023080651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602219
Report Date: 10/17/2023
Date Signed: 10/17/2023 11:02:51 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 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
07/25/2023 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20230725090411

FACILITY NAME:	AMBITIONS - 183RD STREET		FACILITY NUMBER:	198602219
ADMINISTRATOR:	LESLYN VENEGAS		FACILITY TYPE:	735
ADDRESS:	11417 183RD ST		TELEPHONE:	(562) 219-5799
CITY:	ARTESIA	STATE: CA	ZIP CODE:	90701
CAPACITY:	3	CENSUS: 3	DATE:	10/17/2023
		UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Administrator Tranae Gatlin		TIME COMPLETED:	11:16 AM

ALLEGATION(S):

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Resident sustained unexplained injuries due to lack of staff supervision.
Staff are not providing authorized representative access to resident records.
Staff do not maintain a comfortable temperature for resident(s) in care.
Staff do not ensure that resident engages in activities while in care.

INVESTIGATION FINDINGS:

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On 10/17/23 at 9:53 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted two (2) unannounced complaint visits to the facility in conjunction to deliver findings. Upon arrival LPA met with staff S1 who called the Administrator Tranae Gatlin and explained the purpose of the visit. Administrator Tranae Gatlin arrived at 10:18 a.m.

During the initial visit on 08/01/2023 LPA toured the facility with staff S2. LPA obtained resident roster, staff roster, pictures of facility property damage, pictures of R1’s injuries and a photo of the thermostat. LPA also interviewed: Program Manager Christopher Young and a total of two (2) staff who shall be referred to as S1, and S2. LPA attempted to interview a total of 3 residents who shall be referred to as: R1 through R3. Due to the residents’ limited communication LPA was not able to use resident’s interviews. LPA was unable to conduct file review due to the administrator having the keys to provide access to the files. Prior to the visit LPA received R1's Individual Person-Centered Plan and Interviewed Case Manager for R1 who shall be referred to as witness #1 (W1). (Report continued on 9099c)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230725090411

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: 10/17/2023

NARRATIVE

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The investigation reveals the following: Regarding " Staff are not providing authorized representative access to resident records”. The Program manager denied the allegation stating they have provided documentation to R1’s responsible party, but it was not enough. 2 out of 2 staff stated they are not involved in providing documentation to the resident responsible party. W1 confirmed the facility has tried their best to assist R1’s responsible party. W1 further stated R1 is not conserved, and the facility has tried to work with R1’s responsibility party within those limits.

The investigation reveals the following: Regarding " Resident sustained unexplained injuries due to lack of staff supervision”. It is alleged that R1 has unexplained injuries. The Program manager denied the allegations stating R1 sustained those injuries because of R1’s destructive behaviors. 2 out of 2 staff stated R1 has destructive behaviors and they have always redirected R1 during those behaviors. W1 confirms R1 has destructive behaviors, and they are working to combat those behaviors. LPA toured the facility and observed the destruction caused by R1. LPA also reviewed R1’s file and observed R1 has a history of aggressive behavior.

The investigation reveals the following: Regarding " Staff do not maintain a comfortable temperature for residents in care. LPA interviewed the Program Manager and confirmed the thermometer is adjustable and there are no issues with the device. 2 out of 2 staff stated there have been no issues with temperature. W1 confirmed they have not heard of any issues with the temperature. LPA toured the facility and observed the thermometer was at 74 degrees F. and the facility was at a comfortable temperature.

Report continued on 9099c

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 28-AS-20230725090411

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: 10/17/2023

NARRATIVE

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The investigation reveals the following: Regarding " Staff do not ensure that the resident engages in activities while in care. “The Program manager denied the allegation stating they have bought numerous things for R1, and the facility takes the residents on outings to the beach and the park. The Program manager further stated R1 is supposed to be in school but due to an incident the doctor has to sign off before R1 can go back to school. 2 out of 2 staff stated R1 has a lot of activities. W1 stated R1’s not going to school has nothing to do with the facility and ultimately was the decision of R1’s responsible party. LPA observed the facilities activity calendar and observed activities such as trampoline and games was present at the facility.

Based on LPA's interviews, investigation revealed: 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 conducted with Tranae Gatlin and a copy of this record provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

LIC9099 (FAS) - (06/04)

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