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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602558
Report Date: 01/31/2022
Date Signed: 01/31/2022 04:32:30 PM

Document Has Been Signed on 01/31/2022 04:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
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:
01/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:LaQuala McKinleyTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1-year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met with Administrator LaQuala Mckinley and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved mitigation plan report. The facility annual fees are current. There are currently two (2) Westside Regional Center (WRC), consumers in placement. The following Domain will be observed and reviewed: Infection Control Practices "I will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections."
The facility is a single-story family home located in a residential neighborhood. Ms. McKinley and LPA Bunker made a complete tour of the facility which consisted of a Living room, three (3) bedrooms, two (2) bathrooms, dining area, kitchen, laundry room, detached garage, shaded area, indoor/outdoor activity areas. Bedrooms #1-3 are designated as the client's bedrooms. Each bedroom has one client to a room.
Documents are posted as mandated at the entrance and on the living room wall. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture. The client’s bedrooms were inspected for safety, privacy, and comfort. The living areas are clean, bathrooms are clean and operational. First aid kit is fully stocked with manual, hot water temperature 109 degrees Fahrenheit, working telephone, smoke and carbon monoxide detectors were in compliance, fire extinguishers are fully charged, medications were centrally stored and properly locked in the kitchen cabinet and records are current, ample supply of perishable and nonperishable food, adequate linen supply, fire/emergency drill conducted on January 04, 2022. No firearms on the premises, client's bedroom windows have no sliding window locks with thumbscrews, all exit doors were in compliance, covered trash cans, and no bodies of water present. Hazardous items are inaccessible to clients, the yard is free of debris and hazards.
Staff was given training on dependent adult and elder abuse reporting.
There were no deficiencies cited. Exit interview conducted
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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