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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602588
Report Date: 12/07/2022
Date Signed: 12/07/2022 01:34:26 PM

Document Has Been Signed on 12/07/2022 01:34 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:AMBITIONS - LONG BEACH DAY PROGRAMFACILITY NUMBER:
198602588
ADMINISTRATOR:MIA PRECIADOFACILITY TYPE:
775
ADDRESS:850 LONG BEACH BLVDTELEPHONE:
(562) 349-0541
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY: 60CENSUS: 11DATE:
12/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:DIRECTOR AMADO ARCIVATIME COMPLETED:
01:30 PM
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On 12/07/2022 at 12:00 PM Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced Annual required visit to Ambitions Long Beach Day Program Facility with a primary focus on infection control measures. LPA Calderon was allowed entry into the facility by Director Amado Arciva. Director Arciva asked infection control questions and took LPA Calderon temperature prior to entrance into the facility and the purpose of today’s visit was explained. The facility is licensed to serve 60 adult clients with behavioral issues.

There are currently 11 clients in care all clients are ambulatory. The facility is a one story commercial structure with (6) rooms and (2) bathrooms, activity room. kitchen and work out room, teaching rooms, computer room and staff offices. On 12/07/2022 at 12:00 PM Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced Annual required visit to Ambitions Long Beach Day Program Facility with a primary focus on infection control measures. LPA Calderon was allowed entry into the facility by Director Amado Arciva. Director Arciva asked infection control questions and took LPA Calderon temperature prior to entrance into the facility and the purpose of today’s visit was explained. The facility is licensed to serve 60 adult clients with behavioral issues.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: AMBITIONS - LONG BEACH DAY PROGRAM
FACILITY NUMBER: 198602588
VISIT DATE: 12/07/2022
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LPA Calderon and Director Arciva toured the physical plant. There is no bodies of water or firearm/ammunition on the premises. All client rooms were checked and are in good condition and well maintained. LPA Calderon noted adequate lighting was provided to staff and clients, storage for client personal belongings was observed. Walls and floors were in good repair. All equipment, computers, work stations are well maintained and there is adequately PPE stocked at the time of visit. LPA Calderon observed Bathrooms were found to be within Title 22 regulations and were clean and operational. LPA Calderon noted the following: Bathroom #1 has no hot water only cold, and bathroom #2 has no hot water only cold, and finally the Kitchen hot water temperature properly measured at 109 degrees Fahrenheit. LPA Calderon 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 not accessible to clients. The facilities’ last fire drill was conducted by staff on 11/28/2022. LPA Calderon noted (13) Smoke detectors all were hard wired, (2) Carbon Monoxide was found in the facility. The facility (2) Fire Extinguishers were checked and found to be fully charged and accessible. Three (3) clients files were reviewed and found to be complete. LPA Calderon reviewed (3) client’s medications and they were all found to be administered according to doctor's orders. Two (3) staff files were checked and have the required documents. The facility does not handle client’s money/cash resources. All the required documents are posted in the facility in a visible area to staff and clients.

During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon did observe screening protocols for visitors, staff and clients, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff were wearing face coverings, an isolation room is confirmed for the facility. LPA Calderon observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPA Calderon advised the Director Arciva to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.



During today’s visit there were no deficiencies under California code of regulation title 22, division 6, chapter 8. Exit interview and copy of the report was provided to Director Amado Arciva.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
LIC809 (FAS) - (06/04)
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