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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602219
Report Date: 12/28/2023
Date Signed: 12/28/2023 10:29:56 AM

Document Has Been Signed on 12/28/2023 10:29 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 STREETFACILITY NUMBER:
198602219
ADMINISTRATOR:LESLYN VENEGASFACILITY TYPE:
735
ADDRESS:11417 183RD STTELEPHONE:
(562) 219-5799
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 3CENSUS: 3DATE:
12/28/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrator Baltazar Cornejo TIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced continuation case management visit to continue the annual inspection. LPA upon arrival met with Agency Staff Courtney Jack and shortly after at 9:15am Administrator Baltazar Cornejo joined visit. LPA explained the reason for the visit.

During today's visit LPA used the CARE inspection Tool to complete annual inspection, did (2) staff interviews and reviewed staff files.

The following was observed, reviewed and inspected:
  • LPA reviewed staff files and all files were in place, staff had CPR/First Aid Certification and were cleared, no deficiencies noted.
  • LPA interviewed (2) staff whom were present during today's visit.

During today's visit no deficiency was cited per California Code of Regulations, Title 22.

An exit interview was conducted. This report is discussed and provided to Administrator Baltazar Cornejo.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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