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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003781
Report Date: 04/21/2023
Date Signed: 04/21/2023 04:45:13 PM

Document Has Been Signed on 04/21/2023 04:45 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 - SUNFIELD AVENUEFACILITY NUMBER:
306003781
ADMINISTRATOR:DAVENPORT, RENEEFACILITY TYPE:
735
ADDRESS:4734 SUNFIELD AVETELEPHONE:
5629824218
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 4CENSUS: 4DATE:
04/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:Renee DavenportTIME COMPLETED:
03:12 PM
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On 4/21/23 Licensing Program Analyst (LPA) Mario Leon arrived at the above mentioned facility to discuss the purpose of todays visit; which involves gathering information surrounding the altercation between Client #1 (C1) and Client #2 (C2), which occurred on 4/13/23. LPA was met by Lucille Heath, Direct Support Professional (DSP1) and later by Administrator Renee Davenport (A1).

Investigation:

LPA interviewed A1, DSP1, Client #1 (client #2 was unavailable) making sure that the clients understand the previous situation and to attempt to understand each other.
DSP1 Informed LPA that C2 was admitted 2/28/23, therefore new to the community.
A1 Informed LPA that C1 and C2 have both apologized to each other and have been getting along well throughout all community outings. A1 also informed LPA that the behavioral team has been coaching C2 to deal with her aggressions better.

A copy of this report was left with Administrator, Renee Davenport.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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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