198602558-6-13-2024-11-AS-SCIS-D6NRE8-20240628125708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602558
Report Date: 05/08/2024
Date Signed: 06/13/2024 07:55:18 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
07/05/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20230705131627

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:	12:30 PM
MET WITH:	Franca Okere		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Client was injured by staff

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 with Administrator Franca Okere, 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: Staff 1-6 (1-6) and clients 2-3 (C2-C3) were interviewed. LPA Bunker was unable to interview C1 she is non-verbal and is no longer residing at the facility. 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 staff do not slap, grab, or hit clients.

See continued LIC812-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-20230705131627

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 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, Westside Regional Center Individual Program Plan (IPP), Admission Agreement, I.D. Emergency Information, Physician's Report, Medical Assessment, Medication, MARs, 2nd Avenue Body Check Form, Client Annual Behavioral Assessment and Support Plan, and ongoing training.

Allegation: Client was injured by staff
LPA Bunker interviewed staff 1-6 (S1-S6), six out of six staff members stated they had not witnessed any staff member injure a client. The Administrator (S1) confirmed that there have been no reports of staff slapping or grabbing clients. S1-S6 affirmed that none of the staff has exhibited aggressive behavior towards clients. In interviews with clients 2-3 (C2-C3), both stated they had not seen staff injure a client, nor had they experienced any hitting, slapping, or grabbing by staff. C1’s Service Coordinator (SC) at Westside Regional Center, stated that the staff at the facility are very good with C1 and have no concerns. S1-S6 and C2-C3 denied the allegation.

The Investigation revealed the following: LPA Bunker interviewed staff members 1-6 (S1-S6) who stated client was not injured by staff. S1-S6 stated the facility enforces 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 that in the five years she's been here she has never witnessed any staff neglect, or physically or verbally abused clients. C3 stated she has never seen staff slap or grab a client. Both C2 and C3 stated they were happy with the care that they were receiving. S1-S6 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-S6 stated any incidents of client injury would be reported promptly through Special Incident Reports to Community Care Licensing, Westside Regional Center, and all the appropriate agencies. During the investigation, no records or documentation indicated that the client was injured while in care. S1-S6 and C2-C3 interviewed denied the allegation.
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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