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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003782
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:47:02 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/21/2022 03:47 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 - 9TH STREETFACILITY NUMBER:
306003782
ADMINISTRATOR:TULANDA, TRESORFACILITY TYPE:
735
ADDRESS:6711 E 9TH STTELEPHONE:
(562) 386-2616
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 4CENSUS: 4DATE:
09/21/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Merlina Leyva TIME COMPLETED:
03:59 PM
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On 09/21/22 Licensing Program Analyst (LPA) Ernand Dabuet conducted a case management - annual continuation visit at this facility. Upon arrival at the facility, LPA greeted and assisted by administrator Marlina Leyva and conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection.

The inspection is an annual continuation from 8/13/22 visit. The visit consisted of health and safety inspection and conducted the ARF Inspection Tool Care questionnaires. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed staff wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

A review of staff tests and residents' vaccination along with daily temperature checks were conducted .on 08/13/22. The facility has an approved Mitigation Plan Report on file with CCLD.

No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a copy of this report was provided to Marlina Leyva. .
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2022
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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