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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602588
Report Date: 12/10/2025
Date Signed: 12/10/2025 12:10:02 PM

Document Has Been Signed on 12/10/2025 12:10 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:AMBITIONS - LONG BEACH DAY PROGRAMFACILITY NUMBER:
198602588
ADMINISTRATOR/
DIRECTOR:		MIA PRECIADOFACILITY TYPE:
775
ADDRESS:850 LONG BEACH BLVDTELEPHONE:
(562) 349-0541
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY: 60CENSUS: 23DATE:
12/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:19 AM
MET WITH:Amado ArcivaTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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On 12/10/25, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Amado Arciva as the purpose of the visit was explained. The day program is licensed for a capacity of (60) developmentally disabled adults. The staff to client ratio is (1) staff to (3) clients. Facility fees are current. Liability insurance current (ex: 1/1/26).

The day program is a large building that consisting of the following: a parking lot (drop off/pick up area), lobby area, 5 classrooms (gym area, art room, game room, music/quiet room, computer room), a cafe area with a refrigerator, stove, and sink (water tested at 108.8 F) with dining area and houses an enclosed washer and dryer area, storage/supply room, administrative offices, 2 bathrooms (men’s and women’s), outside shaded area, and gated driveway. LPA observed plenty of storage space and chemicals were properly locked. The restrooms were clean and within Title 22 regulations. The kitchen was clean and a refrigerator was available for client use. The day program does not provide lunch however provides snacks on occasion to clients. The first aid kit was available and fully stocked. There are no bodies nor obstructions on the premises, walkways throughout the day program and all exits were clear of hazards and debris

LPA conducted a review of (5) client records, and (4) staff records. LB fire Department fire alarm and emergency communication system inspected 03/04/25. Emergency drill conducted on 10/31/25. LPA observed (3) fire extinguishers were observed throughout the facility.

Exit interview conducted, appeal rights explained, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Lizeth Villegas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 12/10/2025 12:10 PM - It Cannot Be Edited


Created By: Lizeth Villegas On 12/10/2025 at 11:28 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: AMBITIONS - LONG BEACH DAY PROGRAM
FACILITY NUMBER: 198602588

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068.2(d)(1)
82068.2 Needs and Services Plan
If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: The needs appraisal or IPP is not more than one year old.
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA did not observe a current IPP for clients #1 and # 3 (C1 and C3) or documentation indicating that IPPS have been requested from service coordinators which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/24/2025
Plan of Correction
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Licensee/Director to obtain copies of current IPPS for C1 and C3 and ensure a copy is placed in clients files, or place in clients file any documented communication (email) requesting current IPPS. LPA to obtain copies of IPPS for C1 and C3 by POC due date. Licensee/Director to ensure all clients records are up to date.
Type B
Section Cited
CCR
82069(b)(1)
82069 Medical Examination
The medical assessment shall include the following: The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as there was no TB test not TB test results for Client #2 (C2) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/24/2025
Plan of Correction
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Licensee/Director to obtain documented proof that C2 has a TB test on file, and send copy to LPA by POC due date. Lizeth.villegas@dss.ca.gov
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Janae Hammond
NAME OF LICENSING PROGRAM MANAGER:
Lizeth Villegas
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2025


LIC809 (FAS) - (06/04)
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