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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602558
Report Date: 01/10/2024
Date Signed: 01/18/2024 09:21:26 PM

Document Has Been Signed on 01/18/2024 09:21 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
EL SEGUNDO ASC, 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:
01/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Franca Okere and Ashley HowellTIME COMPLETED:
03:45 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 Franca Okere and staff Ashley Howell and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved Mitigation Plan Report and an Infection Control Plan. There are currently two (2) Westside Regional Center clients in placement. The facility's annual fees are current. The facility is a single-story family home located in a residential neighborhood with, a living room, dining area, kitchen, 3 bedrooms, 2 bathrooms, office area, laundry room, detached garage, and an indoor/outdoor activity area. A shaded area with outdoor patio furniture, tables, and chairs. Bedrooms #1-3 are designated as the resident's bedrooms. During the tour, LPA Bunker observed sanitizer, visitor log, and thermometer at the facility entrance. Logs of daily COVID-19 screening and temperature checks of clients and staff were available and updated. PPE supplies are readily available to staff, and an additional supply of PPE was observed. Sufficient liquid soap, paper goods, cleaning, and disinfecting supplies were observed. Documents have been diligently 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, and bathrooms are clean and operational. Personal accommodations were observed for safety, privacy, and comfort, including the provision of non-skid surface mats. The kitchen was observed for its ability to prepare and serve food. The food service was reviewed for appropriate quantity and proper storage; there was an ample supply of perishable and nonperishable food. The client’s medications were reviewed for proper storage, documentation, and system implementation. Medications are securely locked, and records are current and up to date. Common areas observed for the ability to safely serve the needs of the clients, including cleanliness, and clear of any potential hazards to the clients. The first aid kit is fully stocked with manual, smoke, and carbon monoxide detectors were in compliance, the hot water temperature was measured within normal limits at 110 degrees Fahrenheit (within the range of 105-120 degrees Fahrenheit). The fire extinguisher is fully charged, adequate linen supply, and the facility's telephones are tested and found to be in working order, The client's bedroom windows have no sliding window lock with thumbscrews, all exit doors were found to be in compliance, the yard was free of debris hazards, and trash cans were covered. Staff members have undergone training on reporting dependent adult and elder abuse. Due to time constraints, LPA Bunker will return at a later date to conclude the visit. There were no deficiencies cited. Exit interview conducted.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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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