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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602220
Report Date: 03/13/2024
Date Signed: 03/13/2024 10:36:48 AM

Document Has Been Signed on 03/13/2024 10:36 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
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: 2DATE:
03/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Administrator Kelli PinkneyTIME COMPLETED:
10:50 AM
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On 03/13/2024, Licensing Program Analyst (LPA) Regina Cloyd conducted a Case Management visit to serve an "ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM FACILITY" for Staff #1 to Administrator Kelli Pinkney.

An investigation by the California Department of Social Services was conducted; and it was determined that staff S1 violated resident C1's Personal Rights. Government Code Section 11522 was issued informing of Staff #1 an "excluded" person may petition for reinstatement to the Department no less than one (1) year after the effective date of the Exclusion Order.

LPA Cloyd delivered (in person) to the facility the "Immediate Exclusion" letter for Staff #1 to the Administrator, Kelli Pinkney. It should be noted that copies of the letters will be sent (via "certified" U.S. Mail) to both parties. An exit interview was conducted and copy of this report provided to Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2024
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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