<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602588
Report Date: 12/09/2021
Date Signed: 12/10/2021 10:31:40 AM

Document Has Been Signed on 12/10/2021 10:31 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:AMBITIONS - LONG BEACH DAY PROGRAMFACILITY NUMBER:
198602588
ADMINISTRATOR:WALLACE, ALYCIAFACILITY TYPE:
775
ADDRESS:850 LONG BEACH BLVDTELEPHONE:
(562) 349-0541
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY: 60CENSUS: 20DATE:
12/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Leslyn VenegasTIME COMPLETED:
02:45 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
On 12/9/21, at 1:27 pm, Licensing Program Analyst (LPA) Susan Campos conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with Leslyn Venegas, Program Manager and explained the purpose of today’s visit. The Adult Day Program facility is licensed to operate for developmentally disabled clients, hours of operation are 8:00 a.m. – 5:00 p.m., Monday through Friday. Currently, program client facility service hours are from 12:30pm-3:00pm. The staff client ratio is 1:3. Facility is located in a commercial downtown area and is composed of one building with multiple rooms and separate executive office suites. The front entrance is located in the rear of the building that includes a parking lot with a fenced in area with a secured gate. The layout of the Day program consists of a large common area with a multi-purpose areas (exercise area, café kitchen with bistro, and individual rooms that contain a computer lab, quiet area/music room, and art room), reception area and management office. Also, the quiet/respite room has a sofa, and pillows. The art room is used to construct art projects and has, tables/chairs, art supplies, accessories, equipment, paint, organized within wall units or a mobile cart. The multi-purpose area has games, puzzles, cards, and sensory objects to support fine motor skills. Clients can store their personal belongings in designated lockers along the wall near the reception area. Male and female bathrooms are located near the front of the building. The hot water temperature measured at 109.9 degrees Fahrenheit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The entrance at the back of the building is free of hazards, debris and clutter. Kitchen contains a stainless-steel bar bistro area for cooking preparation, (2) dining tables with dining set with chairs and a bench, appliances include: refrigerator, stove, oven, microwave, and coffee maker. The knives are stored and locked and inaccessible to clients. This day program does not provide meals but snacks are served. Toxins, cleaning agents and cleansing wipes were stored in metal cabinet with

Evaluation Report Continues on LIC 809-C

SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Susan Campos
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: AMBITIONS - LONG BEACH DAY PROGRAM
FACILITY NUMBER: 198602588
VISIT DATE: 12/09/2021
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
26
27
28
29
30
31
32
metal lock and inaccessible to the consumers. LPA observed notifications and postings at the front entrance of the building. There were (8) dual smoke/carbon monoxide detectors tested, and observed to be functioning properly. There were (2) fire extinguishers located in the front and back entrance of the building up to date and fully charged. The last fire drill was conducted on 10/21/21. During the visit, LPA observed the facility infection control practices. A first aid kit and manual, located in the management office, was inspected and is complete. There are no bodies of water, firearms or pets observed in this building. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff and residents were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

No deficiencies were cited during this inspection visit.



An exit interview was conducted and a copy of this report was provided to Leslyn Venegas
.
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Susan Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2