198602558-6-7-2024-11-AS-SCIS-D72U88-20240710152105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602558
Report Date: 05/08/2024
Date Signed: 06/07/2024 09:57:29 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
06/20/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20230620091807

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:	05/08/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Franca Okere		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Client sustained injuries due to staff neglect
Client wandered away from facility due to staff neglect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, May 08, 2024. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met administrator Franca Okere, and staff Jennifer Flores, and spoke to the Program Manager Letica Woods via telephone. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: During the course of the investigation staff members 1-6 and clients 2 were interviewed. LPA attempted to interview C1 was non-verbal. Staff records and client records were requested observed, and reviewed. LPA Bunker asked questions relevant to the nature of the complaint. LPA Bunker requested copies of supporting documents. S1-S6 stated client did not sustain any injuries due to staff neglect. S1-S6 stated they did not witness any physical abuse by staff. S1-S6 stated staff do not hit clients. S1-S6 stated clients do not wander away. The facility has emergency exit doors and the doors would buzz when you enter and exit the door. See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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-20230620091807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 - 2ND AVENUE	FACILITY NUMBER: 198602558
	VISIT DATE: 05/08/2024

NARRATIVE

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Continued LIC9099-C page 2

LPA Bunker requested and reviewed the following documents: Staff and Clients Roster, Special Incident Reports, In-Service Training, Training on Client Care, Training on Client Abuse, Client Progress Notes, undergone training on reporting dependent adult and elder abuse, Client Needs and Services Plan, Admission Agreement, I.D. Emergency Information, Physician's Report, Medical Assessment, Medication, MAR, Client Annual Behavioral Assessment and Support Plan, ongoing training, and Westside Regional Center Individual Program Plan (IPP)

The client sustained injuries due to staff neglect
During interviews with staff (S1-S6), six out of six staff stated they had not witnessed another staff member physically abuse or neglect any clients. S1-S6 stated staff do not give clients cold showers. The Program Director Letica Woods, stated there have been no other reports of staff neglecting clients. S1-S6 stated staff have not shown any aggressive behavior toward clients in the past. Interviews with client 2 (C2), stated she has not seen staff neglect any client. S1-S6 stated they did not observe any injuries or bruises on their client's bodies. The Service Coordinator (SC) at Westside Regional Center, stated staff at the facility are providing care and supervision and are very good with the clients and they have no concerns. S1-S6 denied the allegation.

The client wandered away from the facility due to staff neglect
Interviews with staff 1-6 (S1-S6), six out of six staff stated they had not witnessed a client wander away. The Program Director, stated this incident about the client wandering off happened a long time ago and it was reported and resolved. This incident was handled and is not a current incident. S1-S6 stated clients do not wander away. The facility has emergency exit doors the door will sound if a client tries to exit the facility. LPA interviewed the Service Coordinator (SC) at Westside Regional Center, they stated the staff at the facility are very good with C1 and they have no concerns. S1-S6 denied the allegation.
See continued LIC812-C page 3

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230620091807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 - 2ND AVENUE	FACILITY NUMBER: 198602558
	VISIT DATE: 05/08/2024

NARRATIVE

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Continued LIC812-C page 3

The Investigation revealed the following:
Staff 1-6 and C2 were interviewed and stated client did not sustain any injuries due to staff neglect. S1-S6 stated the facility has a Zero Tolerance Policy. S1-S6 stated staff do not physically or verbally abuse clients. S1-S6 stated they are mandated reporters. If they see something they will say something. C2 stated she never witnessed any staff neglect, or physically or verbally abused clients. C2 stated she was happy with the care she was receiving. S1-S6 and C2 stated staff do not hit clients or give clients cold showers. The hot water temperature was measured at 110 degrees Fahrenheit within the normal limits (105-120F degrees). S1-S6 and C2 stated none of the clients eloped from the facility. The facility has emergency exit alarms that will sound if the doors are opened. During the visit, we tested the emergency exit doors and they were operable condition. Staff 1-6 stated all clients are treated with dignity and respect. The facility has sufficient staff available, trained, and competent to provide the services necessary to meet client's needs. S1 and S3 stated they self-reported Special Incident Reports to Community Care Licensing, Westside Regional Center, and all the appropriate agencies in a timely manner. S1-S6 and C2 interviewed denied the allegations.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.

There were no deficiencies cited

Exit interview conducted

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC9099 (FAS) - (06/04)

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