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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603011
Report Date: 09/16/2024
Date Signed: 09/16/2024 02:52:53 PM

Document Has Been Signed on 09/16/2024 02:52 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:INTEGRATED TREATMENT SERVICES IIIFACILITY NUMBER:
198603011
ADMINISTRATOR/
DIRECTOR:		AUBRI GRIFFISFACILITY TYPE:
737
ADDRESS:15331 S AINSWORTH STTELEPHONE:
(310) 916-7200
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 3CENSUS: 3DATE:
09/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Mary Jiminez, House LeadTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 9/16/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced follow-up visit at the facility listed above. LPA arrived at facility and explained the purposed of the visit was to interview staff that were missed or could not be contacted on the initial day of investigation.

LPA Shirley spoke to facility administrator, Aubri Griffis by phone and requested contact information for two staff. LPA also spoke to staff 4 and staff 6(S4 & S6).

Due to insufficient information available at this time, the above allegations need further investigation.

An exit interview was conducted with House Lead, Mary Jiminez and a copy of the report was provided.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
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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