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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602220
Report Date: 11/30/2023
Date Signed: 11/30/2023 02:09:23 PM

Document Has Been Signed on 11/30/2023 02:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:AMBITIONS - BRIGHTON AVENUEFACILITY NUMBER:
198602220
ADMINISTRATOR:KELLI PINKNEYFACILITY TYPE:
735
ADDRESS:21325 BRIGHTON AVETELEPHONE:
(310) 817-6100
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 3CENSUS: 3DATE:
11/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Kelli PinkneyTIME COMPLETED:
02:20 PM
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On 11/30/2023, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced annual required visit using the CARE Inspection Tool. Upon arriving at the facility, LPA met with Administrator Kelli Pinkney and explained the purpose of this visit. LPA was granted access and allowed to enter the facility to conduct an inspection by the Administrator. The facility is licensed to serve three (3) ambulatory, of which one may be non-ambulatory, clients ages 18-59. Clients are referred by the Harbor Regional Center.

LPA toured the single-story facility with Administrator The facility consists of three (3) client bedrooms, kitchen, dining area, living room, two (2) bathrooms, washer/dryer located in garage, office area, and backyard patio. Centrally stored medications are locked in a cabinet in the hallway.

There is at least a one week supply of nonperishable and two day supply of perishable foods. The facility is maintained at a comfortable temperature. Hot water temperature measures at 114.0 degrees Fahrenheit. There are working lights in each room to ensure safety and comfort for all clients in the facility.

All outdoor and indoor passageways were free of obstruction. The clients have clean linen which includes blankets/bedspreads, top and bottom sheets, pillow cases, and mattress pads. First aid kit had the required items. This facility has an operable smoke and carbon monoxide detector in the foyer. LPA observed two (2) fire extinguishers last serviced on 1/18/2023. One fire extinguisher is located in the kitchen and another one in the garage. Facility last fire drill was on 11/10/2023.

Five (5) staff records were reviewed and two (2) staff were interviewed. As of 04/28/2015, the licensee has an administrative file approval and all criminal records are associated to Ambitions - 184th Place (198601016) located at 3902 W. 184th Place Torrance, CA 90504.

Three (3) client records were reviewed and, 3 out of 3 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. LPA Cloyd reviewed P&I money, 1 out of 1 client's P&I were intact and were not commingled with facility funds or petty cash. One (1) client was interview and (1) medication record was reviewed.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: AMBITIONS - BRIGHTON AVENUE
FACILITY NUMBER: 198602220
VISIT DATE: 11/30/2023
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No deficiencies cited.

An exit interview was conducted and technical assistance was provided. A copy of this report was discussed and left with the Administrator Kelli Pinkney.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
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