198602558-11-27-2023-11-AS-MVAO-CXZU32-20231128141249

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602558
Report Date: 07/07/2023
Date Signed: 11/27/2023 12:27:52 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/07/2023 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20230607131956

FACILITY NAME:	AMBITIONS - 2ND AVENUE		FACILITY NUMBER:	198602558
ADMINISTRATOR:	WOODS, LETICIA		FACILITY TYPE:	735
ADDRESS:	10421 S 2ND AVE		TELEPHONE:	(323) 920-7174
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90303
CAPACITY:	3	CENSUS: 2	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Blanca Esparza		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff hit resident.
Staff handled resident in a rough manner.

INVESTIGATION FINDINGS:

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On 11/27/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a subsequent visit to the facility listed above to deliver an amended LIC9099-C. LPA met with Administrator, Franca Okere, and the purpose of today’s visit was explained.
On 07/07/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a subsequent visit to the facility listed above. LPA met with Client Care Coordinator, Blanca Esparza, and the purpose of today’s visit was explained. During today’s visit, LPA toured the facility and interviewed Client (C2).
A previous visit was conducted on 6/15/2023 to initiate the complaint investigation. During previous visit, LPA Gibbs met with Direct Support Professional (DSP), Veronica Pena.
During the first visit, LPA Gibbs toured the facility, reviewed, and received copies of staff Mandated Reporting Training and Statement Acknowledgement to Report Suspected Abuse, Client’s (C1 & C2) IPP, Behavior Report, Physicians Report, Needs and Service Plan, and Functional Behavior Assessment. LPA Gibbs interviewed Program Director of the facility, Staff (S2-S6), C1’s co-conservator, C1’s Service Coordinator at Westside Regional Center, Witness (W1) and attempted an interview with Client (C1).
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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 11-AS-20230607131956

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AMBITIONS - 2ND AVENUE	FACILITY NUMBER: 198602558
	VISIT DATE: 07/07/2023

NARRATIVE

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Allegation: Staff hit resident.

The details of the complaint alleged a client was hit in the head by the perpetrator. During interviews with staff (S2-S6), five out of five staff stated they have not witnessed another staff member hit a client. During interview with the Program Director (PD), stated there have been no reports of staff hitting clients, and there have been no previous reports or complaints regarding staff (S1). Additionally, PD stated S1 has shown no aggressive behavior towards clients in the past. Interviews with client (C2), stated they have not seen staff hit a client nor have they been hit by staff. C1 stated S1 was in the kitchen cooking and W1 was working with C1 during the time of incident. During interview with C1’s Service Coordinator (SC) at Westside Regional Center, they stated the staff at the facility are very good with C1 and they have no concern with C1 remaining at the facility.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Allegation: Staff handled resident in a rough manner.

The details of the complaint alleged a client was handled rough by the perpetrator. During interviews with staff (S2-S6), five out of five staff stated they have not witnessed another staff member handle a client roughly. During interview with the Program Director (PD) there have been no reports of staff handling clients in a rough manner and no previous reports or complaints regarding staff (S1). Additionally, PD stated S1 has shown no aggressive behavior towards clients in the past. Interviews with client (C2), stated they have not seen staff handle a client roughly nor have they been handled in a rough manner. During interview with C1’s Service Coordinator (SC) at Westside Regional Center, they stated the staff at the facility are very good with C1 and they have no concern with C1 remaining at the facility.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited during today's visit.

An exit interview was conducted with Client Care Coordinator, Blanca Esparza , and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

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