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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003964
Report Date: 10/15/2021
Date Signed: 10/15/2021 01:09:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2021 and conducted by Evaluator Linda M Almaraz
COMPLAINT CONTROL NUMBER: 28-AS-20210721152357
FACILITY NAME:AMBITIONS - VAN RUITEN STREETFACILITY NUMBER:
306003964
ADMINISTRATOR:PENALOSA, NICKFACILITY TYPE:
735
ADDRESS:9284 VAN RUITEN STTELEPHONE:
(310) 817-6100
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:4CENSUS: 4DATE:
10/15/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Celeste Orellana, Administration TIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Residents sustained injuries while in care
Staff makes inappropriate comments towards residents
Staff encouraged a resident to engage in a physical altercation with another resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA's) Luis Mora and Linda Almaraz made a subsequent unannounced visit to conduct a complaint investigation for the allegations listed above. LPA's were greeted by staff member Keishoa Spencer and explained the reason for today's visit. Later around 9:49AM, Administrator, Celeste Orellana arrived to the facility.

The investigation consisted of the following: On 7/30/2021, LPA's Alberto Lopez and Linda Almaraz interviewed Clients #1-4, Staff #1-3, former Staff #4 and the Administrator. LPA's also attempted to interview former Staff #5 and #6 but was unsuccesful. LPA's toured the living room area. LPA's requested copies of clients and staff rosters, incident reports and staff files for Staff #5 and Staff #6. On 10/15/2021, LPA Mora and Almaraz interviewed Staff #5 and #6 telephonically and Staff #7 at the facility. LPA's requested files for Client #1 and #4 and training records for staff.

The investigation revealed the following: (Continued on an LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Linda M Almaraz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 28-AS-20210721152357
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: AMBITIONS - VAN RUITEN STREET
FACILITY NUMBER: 306003964
VISIT DATE: 10/15/2021
NARRATIVE
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It was alleged a resident sustained injuries while in care, based on interviews conducted with staff and residents there is a client at the facility who is very aggressive towards staff and other residents. Based on interviews with staff sometimes the client will injure their arm by scratching. On 1/13/2021, Client #1 got up from his seat abruptly and aggressively approached Client #4 and asked if the other client wanted to fight. Client #4 immediately punched Client #1 on the side of the face. Per staff interviews, they immediately intervened and separated the clients. The injury was not from a staff rather from another client and they immediately separated them. On that day (2) staff were present. On another occasion sometime in April of 2021, it was alleged that Staff #4 had hit Client #1 with a chair, based on interviews conducted it revealed the client was not hit a chair. Staff #4 denies being the person who picked up the chair and stated the client is the one who picked up the chair. Staff #5 stated that Staff #4 did pick up the chair but did not hit the client with it but was using it as away to lure the client back into their room.

It was alleged that staff make inappropriate comments towards clients, such as cursing at them. Based on interviews with clients the staff do not curse at them. Two (2) out of (7) seven staff stated they have heard staff curse at residents. Five (5) caregivers stated they have never been told by any of the clients that staff have made inappropriate comments or cursed at them and they also have never witnessed it.

Allegedly a staff encouraged a client to engage in a physical altercation with another client. Based on interviews conducted all the clients at the facility are aware that Client #1 can be aggressive towards staff and they always try to defend staff. Per interviews with staff, the staff at the facility do not allowed them to intervene and ask the clients to step aside and away from the area when Client #1 is having an episode. Sometime in April of 2021, it was alleged that Client #1 became aggressive with Staff #4 and the staff member started calling Client #4 for help. It is alleged that Client #4 came and hit Client #1 with an open hand in the back. Client #1 stated that Client #4 socked the client in the eye and gave the client a black eye. Based on interviews with the other two (2) clients they did not witness Client #4 hitting Client #1. Staff #4 denies calling Client #4 for help and stated the staff was telling Client #1 that they were going to call another staff member. Client #1 is known to lie about injuries that are self inflicted.

Based on LPA's interviews conducted, observations and records reviewed, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted with the Administrator and a hardcopy was provided.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Linda M Almaraz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2