198602219-11-21-2023-28-AS-LHIS-CYMP8F-20231218100528

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602219
Report Date: 11/21/2023
Date Signed: 11/21/2023 09:33:09 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
10/24/2023 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20231024093323

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:	11/21/2023
		UNANNOUNCED	TIME BEGAN:	08:52 AM
MET WITH:	Administrator Tranae Gatlin		TIME COMPLETED:	09:48 AM

ALLEGATION(S):

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Staff withheld residents medications
Staff withheld food from residents
Staff assaulted resident
Staff barricades residents in their rooms

INVESTIGATION FINDINGS:

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On 11/21/2023 at 8:52 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent complaint visit to investigate the above allegations. Upon arrival LPA met Staff #1 (S1) and explained the reason for the visit. S1 contacted Administrator Tranae Gatlin via phone. The Administrator Tranae Gatlin arrived at 9:20 a.m., and LPA explained the reason for the visit.

During the initial visit: A physical plant tour of interior facility was completed; with a focus on the kitchen. During the tour LPA Baptiste reviewed medication, and food supply. LPA obtained a copy of staff roster, resident roster, IPP’s for all 3 clients, Body checks dated 10/16/2023- 10/29/2023 for all 3 clients, Medical Administration records for all clients in the month of October, Medication Verification Record for the month of October, Facility Menu dated 10-1/2023- 10/7/2023 and 10/29/2023- 11/4/2023, and the contact information for staff who worked with S1 for the last 2 weeks. LPA interviewed Staff#1 through staff#3 who shall be referred to as S1-S3 and Program Manager Christoper Young.
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: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

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-20231024093323

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: 11/21/2023

NARRATIVE

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Prior to today’s visit LPA interviewed 5 staff who shall be referred to as S4 through S8. LPA also interviewed the client’s case manager who shall be referred to as Witness #1 (W1).

The investigation reveals the following: Regarding “Staff withheld resident’s medications”. It is alleged that S1 withheld medications from two (2) of the clients. The Program Manager denied the allegations stating they have not seen S1 withheld medication. 8 out of 8 staff denied the allegations stating during their shift they have never witnessed staff withholding medications. W1 stated they did not receive incident reports regarding missed medications, nor have they heard that staff was withholding medications. LPA reviewed S1 file and did not observe any disciplinary actions.

The investigation reveals the following: Regarding “Staff withheld food from residents”. It is alleged that S1 withheld food from two (2) of the clients. The Program Manager denied the allegations, stating they have not seen S1 withheld food. 8 out of 8 staff denied the allegations and stated during their shift they have never witnessed staff withholding food. W1 stated they had not heard that the staff was withholding food. LPA reviewed S1 file and did not observe any disciplinary actions.

The investigation reveals the following: Regarding “Staff assaulted resident”. It is alleged that S1 assaulted two (2) of the clients. The Program Manager denied the allegations stating they have never had any behavioral issues or complaints against S1. 8 out of 8 staff denied the allegations stating during their shift they have never witnessed staff assaulting any of the residents. W1 stated they had not heard that staff was assaulting the residents. LPA reviewed S1 file and did not observe any disciplinary actions.

The investigation reveals the following: Regarding “Staff barricades residents in their rooms”. It is alleged that S1 barricaded the residents. The Program Manager denied the allegations stating none of the staff reported that residents were barricaded in their room. 8 out of 8 staff denied the allegations stating during their shift they have never witnessed staff barricading residents in their rooms. 1 out of 8 staff further stated they have seen staff sit in the residents’ rooms to keep them from going into the kitchen. W1 stated they have not heard that residents were barricaded in their rooms. LPA reviewed S1 file and did not observe any disciplinary actions.

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: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

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