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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003781
Report Date: 02/22/2024
Date Signed: 02/22/2024 02:00:57 PM

Document Has Been Signed on 02/22/2024 02:00 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:DAVENPORT, RENEEFACILITY TYPE:
735
ADDRESS:4734 SUNFIELD AVETELEPHONE:
(562) 982-4218
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 4CENSUS: 4DATE:
02/22/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Renee Davenport TIME COMPLETED:
10:47 AM
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On 02/22/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Case Management visit at this facility. Upon arrival, LPA conducted a risk assessment. LPA spoke with administrator Renee Davenport who confirmed the facility has no COVID activity. LPA explained the purpose of the visit was to conduct a health and safety inspection.

On 02/18/24, Davenport reported an incident concerning client #1 (C1) and staff #1 (S1) involving physical assault. The Department interviewed administrator #1 (A1) Renee Davenport regarding the incident involving (C1) and (S1). Interviews with clients between 10:10 am through 10:30 am clients #1-#3 (C1-C3). As Client #4 was out in the community, (C4) could not be interviewed.

The entire facility was inspected for health and safety, and service records for (C1) and personnel records for (S1) were provided.

An exit interview was conducted with Renee Davenport and a copy of the report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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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