198602558-10-18-2024-11-AS-SCIS-DB2UNX-20241115144440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602558
Report Date: 10/10/2024
Date Signed: 10/18/2024 03:17:41 PM

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
03/19/2024 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20240319110132

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:	10/10/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Franca Okere		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff abandoned client
Staff speaks inappropriately to clients
Staff does not provide client assistance with personal care and maintenance of personal hygiene.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Thursday, October 10, 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. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: During the course of the investigation. Interviews were conducted with staff members 1-4 (S1-S4) and clients 1-2 (C1-C2). LPA Bunker asked questions relevant to the nature of the complaint. LPA Bunker toured the entire facility to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visits. Client records were requested observed, and reviewed. LPA Bunker requested copies of supporting documents.

See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 11-AS-20240319110132

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: 10/10/2024

NARRATIVE

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Continued LIC9099-C page 2

LPA Bunker requested and reviewed the client's records and asked for copies of the following documents: Personnel report, Client Roster, Special Incident Reports, Admission Agreement, Identification and Emergency Information, Physician's Report, Medical Assessment, Medication Administration Records (MARs), Medication Logs, Consent Forms, Appraisal and Needs Service Plan, Client Progress Notes, Westside Regional Center Individual Program Plan (IPP), Client Annual Behavioral Assessment and Support Plan, In-Service Training, Training on Client Care, Training on Client Abuse, Training on Reporting Dependent Adult and Elder Abuse, and any ongoing training.

Allegation #1: Staff abandoned client
LPA Bunker interviewed staff 1-4 (S1-S4), and all stated that they had not witnessed any staff member abandoning a client in care. The Administrator (S1) also verified that there have been no reports or incidents of abandonment. During the interview, Client 1 (C1) claimed that staff had abandoned the client. However, client 2 (C2), stated they never heard of or experienced any instance of staff abandoning a client. S1-S4 and C2 denied the allegation of abandonment.

Allegation# 2: Staff speaks inappropriately to clients.
LPA Bunker interviewed staff members 1-4 (S1-S4), and all four stated that they had not witnessed any staff member speak inappropriately to the clients in care. S1-S4 stated all clients are treated with dignity and respect and the facility enforces a zero-tolerance policy for misconduct. The policy ensures clients are free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other punitive actions. During the interviews, Client 1 (C1) claimed that staff members had spoken inappropriately to clients. However, Client 2 (C2) reported never hearing staff speak inappropriately to clients. C2 stated staff treats clients with dignity and respect, and their daily care needs are being met. S1-S4 stated staff communicates professionally and respectfully, without engaging in inappropriate behavior or language. S1-S4 stated staff prioritizes treating all clients with dignity and courtesy. S1-S4 stated that none of the staff had exhibited aggressive behavior towards clients. S1-S4 and C2 denied the allegation.

See continued LIC9099- C page 3

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20240319110132

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: 10/10/2024

NARRATIVE

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Continued LIC9099-C page 3

Staff does not provide client assistance with personal care and maintenance of personal hygiene.
LPA Bunker interviewed staff members 1-4 (S1-S4), and all four stated that staff provide clients assistance in personal care and hygiene maintenance. S1-S4 stated that staff are trained and continue to receive ongoing training to ensure quality care. S1-S4 also stated that all clients who need assistance are provided with the necessary care and supervision, and their daily care needs are being met. Client 1 (C1) alleged that staff do not provide adequate assistance. However, Clients 2 (C2), reported that their personal care needs are being met, including staff support with hygiene and assistance with pull-ups and diapers. S1-S4 and C2 denied the allegation.

The investigation revealed the following:
LPA Bunker interviewed staff members 1-4 (S1-S4), who stated that staff do not abandon clients. S1-S4 stated that the facility enforces a Zero-Tolerance Policy and that they are mandated reporters—if they witness any concerning behavior, they are required to report it.

Client 2 (C2) stated they had never witnessed staff neglect, abuse (physical or verbal), or abandonment of any client. C2 also stated that staff have always treated clients appropriately and that they were happy with the care provided.

S1-S4 stated that all clients are treated with dignity and respect and that the facility maintains sufficient, trained, and competent staff to meet clients’ needs. S1-S4 stated that staff have never refused to readmit a client returning from the hospital. When clients request a grievance form, staff provide the document along with instructions on how to complete it.

S1-S4 stated that clients’ rights are respected and that no staff member has ever spoken rudely to a client. They also explained that all incidents are reported promptly through Special Incident Reports to Community Care Licensing, the Westside Regional Center, and other relevant agencies.

During the investigation, no records or documentation indicated that any client was abandoned, that staff spoke inappropriately to clients, or that staff failed to provide personal care or hygiene assistance. S1-S4 and C2 interviewed denied all the allegation. See continued LIC9099-C page 4

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20240319110132

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: 10/10/2024

NARRATIVE

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Continued LIC9099-c page 4

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.

An exit interview conducted

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4