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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003781
Report Date: 12/24/2024
Date Signed: 12/24/2024 11:13:58 AM

Document Has Been Signed on 12/24/2024 11:13 AM - 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:
SHELEANIA HAMPTONFACILITY TYPE:
735
ADDRESS:4734 SUNFIELD AVETELEPHONE:
(562) 982-4218
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 4CENSUS: 4DATE:
12/24/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:31 AM
MET WITH:DSP Karen LamasTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 12/24/24, Licensing Program Analyst (LPA) Lizeth Villegas conducted a Case management Health & Safety visit to follow up on an incident that occurred on 12/21/2024. LPA met with DSP Karen Lamas and later joined by Administrator Jolanda Cartridge as the purpose of the visit was explained.

On 12/23/24 Community Care Licensing Division received a SOC 341 alleging Staff #1 (S1) hit Client #1 (C1) in the face with a closed fist. No additional details were provided.

During today’s visit LPA conducted a tour of the physical plant and observed clients in care. LPA conducted a review of C1 file, LPA attempted to review S1's file but was informed S1's file was removed from the facility.
LPA requested copies of C1: Facesheet, emergency ID form, Individual service plan, IPP, needs and service plan, physicians report, physicians orders, conservatorship paperwork, and copies of incident reports dated 08/06/24, 09/27/24, and 12/03/24. On 12/24/24 LPA obtained the following copies for S1, CA ID card, guardian clearance, SOC 341A, LIC 501, LIC 503, CPR, CPI, and training history.

Due to insufficient information available at this time further investigation is needed.

Exit interview conducted, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/24/2024
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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