<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602219
Report Date: 04/02/2024
Date Signed: 04/02/2024 03:04:12 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
03/25/2024 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20240325102654
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: 3DATE:
04/02/2024
UNANNOUNCEDTIME BEGAN:
11:29 AM
MET WITH:Admnistrator Ashilee JacksonTIME COMPLETED:
03:19 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained injuries due to staff neglect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/02/2024 at 11:29 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an initial complaint visit to investigate the above allegation. Upon arrival LPA met Staff #1 (S1) and explained the reason for the visit. S1 contacted Administrator Ashilee Jackson via phone. The Program Director Renee Davenport arrived at the facility at 12:20 p.m., and the Administrator Ashilee Jackson arrived at 12:30 p.m. LPA explained the reason for the visit.

During the visit: A physical plant tour of the interior facility was completed; LPA obtained a copy of staff roster, resident roster, IPP’s for Client #1 (C1), Body checks for C1 for the whole month of March,Ambitions Unusal Incident Report, C1’s behavior episode for month of March, Client progress notes for the month of March, and Day Program provider information. LPA interviewed Staff#1 (S1) through Staff#3 (S3) and Program Manager Renee Davenport. LPA also interviewed C1’s Regional Center Service Coordinator who shall be referred to as Witness #1(W1). Due to the clients limited communication LPA could not use their interviews. (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: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
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-20240325102654
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: 04/02/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation reveals the following: Regarding “Resident sustained injuries due to staff neglect”. It is alleged that staff is abusing C1. The Program Manager denied the allegation stating staff has never abused any of the clients. 2 out of 3 staff denied the allegations stating they have not witnessed staff hurting C1. They further stated C1 has had an increase in aggressive behaviors because of a change in medication and will be re assessed today (4/2/2024). 1 out of 3 staff stated they a new to the facility and has not seen aggressive behaviors from C1. They further stated staff has not abused C1. Witness #1 stated that they visited the home last week and did not note injuries on C1. LPA noted in C1’s IPP that the client has a history of physical aggression, tearing clothes/shoes and self-injurious behaviors. LPA also reviewed C1’s body checks, progress notes, and behavior episode sheet and observed on 1st, 23rd, 25th, 26th and 27th of March C1 has had aggressive behaviors.

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 Program manager Renee Gavenport and Administrator Ashilee Jackson 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: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2