198602219-8-2-2025-28-AS-FFIS-DKAM83-20250806092224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602219
Report Date: 08/02/2025
Date Signed: 08/02/2025 02:51:58 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
08/19/2024 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240819093746

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:	08/02/2025
		UNANNOUNCED	TIME BEGAN:	01:19 PM
MET WITH:	Direct Support Staff- Vivian Yates		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not prevent client from developing multiple stage 2 pressure injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 08/02/2025 to deliver findings regarding the above allegation. LPA Baptiste conducted a Health & Safety visit on 08/20/2024 and a needs further investigation was documented. During today’s visit, LPA Ramirez was greeted by Vivian Yates and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff#1 - 3 interviews (S1 – S3), attempted interview of Client#1 (C1), Interview of with C1’s family members, Unusual Incident/Injury Reports, Appraisal/Needs and services plan, Appointment Records, Client Appointment Communication, Urgent Care Clinical Summary, Body Check forms, Individual Program Plan (IPP) and physical plant tour.

SEE9099-C for continued report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2025

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-20240819093746

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: AMBITIONS - 183RD STREET	FACILITY NUMBER: 198602219
	VISIT DATE: 08/02/2025

NARRATIVE

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The investigation revealed the following: regarding the allegation “Staff did not prevent client from developing multiple stage 2 pressure injuries while in care.” It is alleged staff did not prevent a client from developing stage 2 pressure injuries. During the investigation, LPA Ramirez requested and received C1’s Appraisal/Needs and Services Plan dated 3/12/2024, which indicated that C1 is ambulatory, can independently maneuver through familiar spaces, and C1 often walks on their toes (while their toes are turned in) while barefoot, and enjoys running and/or galloping from space to space. Review of Unusual Incident/Injury Report dated 8/19/2024, revealed that on 8/16/2024, C1’s family observed C1 was limping and took C1 urgent care. Review of C1’s Urgent Care summary dated 8/16/2024, revealed that C1 was observed to have second stage pressure ulcer on right and left distal lower extremity. Review of C1s Body Check form dated 07/01/2024 through 07/31/2024 did not indicate that C1 had a pressure injury during this period. Review of Body Check form dated 08/01/2024, revealed that staff observed and documented an injury to the bottom of C1s heel and foot. Three (3) out of the three (3) staff interviewed denied the allegation. Interview with staff#2 (S2) revealed C1 has a habit of sitting on their feet, however, staff redirect C1 to not sit on their feet. Interview with staff#3 (S3) revealed C1 tends to sit on C1s feet, however, C1 is redirected to sit down on C1s bottom and/or staff will ask C1 if C1 would prefer to go out for walk instead of sitting on C1’s feet. Review of appointment record dated 9/14/2024, revealed C1’s second stage pressure ulcers have healed and C1 may return for follow-up care every 2 months if symptoms re-develop. Due to C1’s limited verbal responses and cognitive abilities, C1 was unable to provide a meaningful interview. The investigation revealed that C1 did develop a stage 2 pressure injury to C1s foot/heel, however, there was no evidence to support that staff neglected C1. 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.

No deficiencies were cited during this complaint investigation. Exit interview conducted. A copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2025

LIC9099 (FAS) - (06/04)

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