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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602558
Report Date: 03/03/2025
Date Signed: 03/03/2025 03:24:34 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/08/2024 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240508133113
FACILITY NAME:AMBITIONS - 2ND AVENUEFACILITY NUMBER:
198602558
ADMINISTRATOR:WOODS, LETICIAFACILITY TYPE:
735
ADDRESS:10421 S 2ND AVETELEPHONE:
(323) 920-7174
CITY:INGLEWOODSTATE: CAZIP CODE:
90303
CAPACITY:3CENSUS: 2DATE:
03/03/2025
UNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Franca Okere/AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff did not dispense medications as prescribed
INVESTIGATION FINDINGS:
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On 3/3/2025 at approximately 2:00 PM, Licensing Program Analyst-LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit following up with the initial investigation of LPA Bunker on 5/13/24. LPA Iniguez met with Franca Okere / Administrator. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: On 5/13/24, the department conducted interviews with facility administrator (A#1) facility staff (S#2) and facility facility clients (C#1 and C#2). In addition, these documents were gathered: copies of staff in-service training, MAR, medication records, medication log, daily notes, progress notes, special incident reports, staff, and client’s roster. On 2/27/25, LPA Iniguez reviewed interviews conducted by LPA Bunker 5/13/24, and drafted LIC 9099 narratives. On 2/28/25, LPA Iniguez observed and reviewed (C#1)’s emergency discharge papers from Cedars Sinai-Marina del Rey Hospital dated 5/7/24.

Evaluation Report continues LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
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-20240508133113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 03/03/2025
NARRATIVE
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Investigation Revealed the Following:

Allegation: Facility staff did not dispense medications as prescribed

The details of the complaint alleged that facility staff gave the wrong medication to C#1.



On 2/28/25, LPA Iniguez observed and reviewed (C#1)’s emergency discharge papers from Cedars Sinai-Marina del Rey Hospital dated 5/7/24. It is written that (C#1)’s diagnosis was chemical conjunctivitis of the right eye. In addition, on February 27, 2025, during records review, LPA Iniguez observed facility’s Plan of Operation/Client Medication Assistance Procedures, the plan stated that facility will adhere to these procedures including assisting with eye drops.

On May 13, 2024, the department conducted an Interview with the Administrator (A#1), she stated that (C#1)’s eye drops are kept in the refrigerator. The name of the prescribed eye drops is Rocklatan, which (C#1) uses one drop in both eyes at bedtime, and Combigan (C#1) uses one drop in both eyes twice daily. (A#1) stated the incident occurred during (C#1)’s bedtime dose when facility staff mistakenly administered ear drops instead of the prescribed eye drops. Upon realizing the error, facility staff and (C#1) called her. (A#1) asked facility staff to take (C#1) to Ocean Urgent Care. Urgent care staff advised them to go to the emergency room at Cedars-Sinai to have (C#1)’s eye flushed out. (A#1) stated that she promptly reported the special incident to the Regional Center, Community Care Licensing, and all appropriate agencies. (A#1) also confirmed that the facility staff is undergoing retraining.

Evaluation Report continues LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20240508133113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 03/03/2025
NARRATIVE
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On March 13, 2024, the department conducted an interview with facility client 1 (C#1), they said they take both ear and eye drops, but facility staff mixed them up. The facility staff member did not read the label properly and put eardrops in my right eye. "It burned like heck." "I don't know if anyone witnessed it". (C#1) stated that another facility staff member who worked the same shift took them to Ocean Urgent Care; they told them to take them to the ER at Cedars-Sinai to have (C#1) 's eyes flushed out.

During this investigation, LPA found sufficient evidence to support the above-mentioned allegation.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 6), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D).

An exit interview was conducted, and a copy of the Complaint Report was given to Franca Okere /Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20240508133113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2025
Section Cited
CCR
85022(a)(2)
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85022 Plan of Operation
(a) In addition to Section 80022, the following shall apply.(2) The plan of operation shall contain written evidence of arrangements for any consultants and community resources which are to be utilized to meet regulatory requirements or requirements of the facility's plan of operation.
This requirement was not met as evidence by:

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Licensee will adhere to Tittle 22 regulations. As plan of correction, licensee will re-train facility staff regarding administering the right medications to clients in care. A copy of this training will be submitted to LPA Iniguez via email before poc due date.
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Based on a review of records and interviews, the facility staff failed to follow regulatory requirements of the facility's plan of operation regarding client/medication assistance procedures when a facility staff administer the wrong medication to C#1. This poses a potential health and safety risk to all clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4