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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 03:34:40 PM

Document Has Been Signed on 11/30/2023 03:34 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:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Kelli PinkneyTIME COMPLETED:
03:45 PM
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On 11/30/2023 at 2:30 PM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced – Case Management Inspection to the above-named facility and met with Administrator Kelli Pinkney. LPA explained the purpose of the visit was to follow up on an incident report sent to the regional office on 11/28/2023. Two clients and two staff were present during the visit.

LPA reviewed client and staff records while on site and requested for the administrator to provide Staff#1 and Client #1 records electronically. Client #1 and Staff #1 was not present during today's visit. LPA also requested for an electronic copy of the Personnel Report (LIC 500) and a copy of staff schedule for three months (September - November 2023).

One staff and one client was interviewed today.

No deficiencies are being cited at this time.

A copy of this report was left with the Administrator.

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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