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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602219
Report Date: 06/11/2024
Date Signed: 06/11/2024 04:02:51 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
06/03/2024 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20240603120033
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:
06/11/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Administrator Ashliee Jackson TIME COMPLETED:
04:17 PM
ALLEGATION(S):
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Resident sustained injuries due to staff neglect
INVESTIGATION FINDINGS:
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On 06/11/2024 at 08:40 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 and the Administrator Ashilee Jackson arrived, and LPA explained the reason for the visit.

During the visit: A tour of the facility was completed. LPA Baptiste observed all clients for bruising and scratching. A copy of the staff roster, resident roster, Ambitions unusual Incident Report’s dated 5/1/2024 and 5/10/2024, and C1’s client progress notes for the month of May was obtained. LPA Baptiste obtained the following documents for all client’s: Individualized personal plan (IPP), Body checks for the month of May, and the Identification and Emergency information. LPA Baptiste interviewed the Program Manager Renee Davenport and the Administrator Ashliee Jackson. LPA interviewed a total of four (4) Staff who shall be referred to as S1 through S4. LPA also interviewed a total of two (2) Regional Center Service Coordinator’s and C1’s responsible party who shall be referred to as Witness #1(W1) through Witness #3 (W3). 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: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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-20240603120033
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: 06/11/2024
NARRATIVE
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The investigation reveals the following: Regarding “Resident sustained injuries due to staff neglect”. It is alleged that a client has bruises on their back and arm. The Program Manager and Administrator stated C1 exhibited bruises due to being hospitalized. On 5/10/2024 C1 collapsed at the facility and was grasping for air. The facility contacted emergency personnel where C1 remained hospitalized from 5/10/2024 – 5/15/2024. During a hospital visit on 5/11/2024 staff stated they witness a bruise on C1’s back when C1 was moving around. 4 out of 4 staff confirmed C1 had bruising on their hands due to the IV. Staff stated that C1 pulled out the IV’s and the medical staff also had a hard time finding a vein. 3 out of 3 witnesses confirmed they did not observe bruises on the clients in relation to staff neglect. W1 stated C1 has never showed signs of neglect or being abused by the facility. W2 confirmed C1 has been hospitalized a total of three (3) times within the last month. LPA reviewed client files and incident reports and confirmed C1’s collapsed which led to hospitalization. LPA also received photos of C1 during hospitalization and observed the bruises caused by the IV.

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 the 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: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2