198602558-1-30-2023-11-AS-MLEN-CNKQZM-20230130113658

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602558
Report Date: 01/30/2023
Date Signed: 01/30/2023 11:37:15 AM

Document Has Been Signed on 01/30/2023 11:37 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

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:	01/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Leticia Woods - Administer		TIME COMPLETED:	11:59 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Mario Leon conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Blanca Esparza, DSP1, and later by Administrator, Leticia Woods. The purpose of today’s visit was explained. The facility is licensed to serve 3 developmentally disabled clients (age 18-59). There are currently (2) Westside Regional Center (SRC) clients in placement. Both (2) clients are ambulatory. The facility is a single-story structure located in a residential neighborhood. Ms. Esparza and LPA Leon made a complete tour of the facility which consisted of the following: 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, bedroom #2 currently vacant. Each bedroom has one client per room. LPA and DSP1 toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 106.7 F in bathroom #1 and 109.9 F in bathroom #2. A comfortable temperature is maintained in the facility at 69 F. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. Fire extinguishers was charged, last charged on 1/21/22, smoke detectors and Carbon Monoxide were operable. SEE LIC 809-C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AMBITIONS - 2ND AVENUE	FACILITY NUMBER: 198602558
	VISIT DATE: 01/30/2023

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During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations (located in common areas and restrooms). LPA observed staff were wearing face coverings, an isolation room and required postings throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE), located in the detached garage.
LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PINs) for any updates relating to COVID-19 guidance.

During today’s visit there were no deficiencies observed.

Exit interview held. A copy of the report was provided to Leticia Woods, Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC809 (FAS) - (06/04)

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