<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602558
Report Date: 01/23/2025
Date Signed: 01/23/2025 11:56:23 AM

Document Has Been Signed on 01/23/2025 11:56 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:AMBITIONS - 2ND AVENUEFACILITY NUMBER:
198602558
ADMINISTRATOR/
DIRECTOR:		WOODS, LETICIAFACILITY TYPE:
735
ADDRESS:10421 S 2ND AVETELEPHONE:
(323) 920-7174
CITY:INGLEWOODSTATE: CAZIP CODE:
90303
CAPACITY: 3CENSUS: 2DATE:
01/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Franca Okere, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 01/23/25 Licensing Program Analyst (LPA) Yolanda Rosser arrived at facility to conduct an unannounced required 1- year visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Rosser conducted a risk assessment. LPA Rosser met with Administrator Franca Okere and staff Tiffany Seymour and explained the purpose of today's visit. LPA verified that the facility has an approved Mitigation Plan Report and a Infection Control Plan. Current census is two (2) Westside Regional Center clients in placement. The facility's annual fees are current.

The facility is a single-story family home located in a residential neighborhood with, a living room, dining area, kitchen, 3 bedrooms, 2 bathrooms, office area, laundry room, detached garage, and an indoor/outdoor activity area. A shaded area with outdoor patio furniture, tables, and chairs. Bedrooms #1-3 are designated as the resident's bedrooms. Bedroom #1 is currently unoccupied. All Bedrooms and bathrooms meet the requirements as established by Title 22. Bedding was clean, mattresses were clean, pillows and extra blankets available. Bathrooms met requirements, grab bars, non- slip mats, hygiene products and extra supplies were stored. Extra supply of towels were stored in closet and cabinets.

Living room had ample seating area, couches, chairs, love seat, which was in good condition. Dining area included a table and chairs for seating. There was a desk and chair for staff with required signs posted. Telephone on desk.

Kitchen contained ample perishable and non-perishable for at least 7 days. Cabinets were stocked full of can goods, rice, beans, spaghetti and other non-perishables. Refrigerator and freezer was fully stocked with meats, vegetables, fruit, juices, water butter, eggs. Kitchen counter was neat and clean free of clutter. Water temperature was measured at 110.9 degrees F. Stove was clean. Cutlery and medication was located in a securely locked cabinet.

Detergents and cleaning products were securely locked and stored in a cabinet in the laundry room. Continued on LIC 809C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Yolanda Rosser
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: AMBITIONS - 2ND AVENUE
FACILITY NUMBER: 198602558
VISIT DATE: 01/23/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA, verified MARS and logs were accurate and up to date. Medication was observed and securely locked.

The garage was used for exercise and activities for the residents. The backyard was landscaped neatly and free of bodies of water and no obstructions or hazards observed. Trash cans were covered . There was a shaded area with a BBQ grill and area for seating and or activities.

The fire extinguisher is fully charged as of 01/20/2025. Staff members have undergone training on reporting dependent adult and elder abuse. There were no deficiencies cited.

Exit interview conducted and a copy of this report was provided to Administrator, Franca Okere.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Yolanda Rosser
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2