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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003781
Report Date: 10/07/2024
Date Signed: 10/07/2024 01:55:33 PM

Document Has Been Signed on 10/07/2024 01:55 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 - SUNFIELD AVENUEFACILITY NUMBER:
306003781
ADMINISTRATOR/
DIRECTOR:		DAVENPORT, RENEEFACILITY TYPE:
735
ADDRESS:4734 SUNFIELD AVETELEPHONE:
(562) 982-4218
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 4CENSUS: 4DATE:
10/07/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:54 PM
MET WITH:China HamptonTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
NARRATIVE
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On 10/07/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Case Management visit at this facility. LPA was greeted by Administrator Jolanda Cartridge who explained the purpose of the visit to close out an investigation for an incident on 02/17/24. Cartridge contacted Program Manager China Hampton by telephone who later joined the visit. LPA explained this visit is in association with health and safety inspections on 02/22/24 and 09/09/24 case management visits.

The investigation revealed that Client #1 (C1) was physically assaulted/abused by staff #1 (S1) on 02/17/24. (S1) violated the personal rights of a client in care by physically striking (C1) several times and using threatening language against the client. (S1’s) physical strikes were witnessed by at least two staff members and one client. Staff have also overheard (S1) used threatening language that is inappropriate in a facility that serves developmentally challenged clients. Staff also witnessed a prior incident in December 2023 of (S1) physically striking (C1). It does not appear that the physical strikes caused injury to (C1), but actual harm is not required to validate unwarranted action. There were separate investigative reports from Harbor Regional Center and Ambitions that contained useful evidence to validate the inappropriate behavior occurred.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiency has been observed and citation issued (ref. LIC 809-D).

An exit interview has been conducted with China Hampton, and a copy of the Evaluation Report and Appeal Rights were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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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Document Has Been Signed on 10/07/2024 01:55 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 10/07/2024 at 12:55 PM
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 - SUNFIELD AVENUE
FACILITY NUMBER: 306003781

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/08/2024
Section Cited
CCR
80072(a)(3)

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80072(a)(3) Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include...(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Licensee/Administrator shall ensure a training for all staff on Title 22, Section 80072 “Personal Rights” is conducted and send the sign in sheets and training materials to the CCLD by the Plan of Correction (POC) due date by 10/08/24.
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This requirement is not met as evidenced by: Staff failed to supervise Client #1 resulting in physical assault/abuse. The investigation did provide witness and internal and HRC investigation. This violatoni poses an immediate health and safety to clients in care.
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Correction provided during visit 10/0724 with In-Service Training Record on 10/04/24.
Staff #1 was terminated of employment 03/01/24.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2024


LIC809 (FAS) - (06/04)
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