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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003964
Report Date: 05/27/2023
Date Signed: 05/27/2023 08:44:05 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
02/11/2021 and conducted by Evaluator Luis Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210211153237
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:
05/27/2023
UNANNOUNCEDTIME BEGAN:
08:09 AM
MET WITH:Gregory Johnson - Direct Support ProfessionalTIME COMPLETED:
08:58 AM
ALLEGATION(S):
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Facility is in disrepair.
Facility failed to provide a comfortable temperature for the residents.
INVESTIGATION FINDINGS:
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This complaint was investigated by Licensing Program Analyst (LPA) Joe Katrdzhyan. Licensing Program Analyst (LPA) Luis Mora conducted an unannounced follow up visit to this facility to assist with delivering findings on the above-mentioned allegations of "Facility is in disrepair” and “Facility failed to provide a comfortable temperature for the residents.” Upon arriving at the facility, LPA met with Gregory Johnson - Direct Support Professional.

LPA Katrdzhyan conducted prior visits to this facility on 2/22/21 and 7/1/21, in reference to the allegations listed above. During the course of the investigation, LPA interviewed the Administrator, Staff members #1 and 2 (S1 & S2) and Clients #1 - 3 (C1 - C3). LPA attempted to interview Client #4 (C4) but was unsuccessful. LPA also obtained/reviewed copies of invoices from Herc Rentals and Cooling & Heating Repair.
(Continued to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2023
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-20210211153237
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: AMBITIONS - VAN RUITEN STREET
FACILITY NUMBER: 306003964
VISIT DATE: 05/27/2023
NARRATIVE
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The investigation revealed the following:

Allegation: Facility is in disrepair. The details of this allegation states that the facility’s heater has been broken for the last several months and the facility administration refuses to fix the heater. (Allegation was reported to Community Care Licensing on 2/11/21).
Based on interviews conducted, the statements obtained did not corroborate with the allegation. Staff and clients interviewed did not present concerns of the facility heater being broken/inoperable during winter of 2020. During the tele visit / virtual tour conducted at the facility on 2/22/21 at 9:15am, LPA observed the reading on the thermostat was at 66 degrees F but the heater was turned on and set at 83 degrees F. LPA observed “Heat On” showing on the bottom of the thermostat. During the course of the investigation, LPA discovered that the air conditioning (AC) unit and not the heater was out of service for a few days in August of 2020 but the Administrator rented a portable AC unit during period 8/18/20 – 8/25/20 to ensure the temperature inside the facility was comfortable for the clients and facility was in compliance with Title 22 Regulations. According to the Administrator, once the AC unit was repaired, the portable AC unit was returned. LPA obtained an invoice from Herc Rentals showing the rental period for the portable AC unit was for period 8/18/20 – 8/25/20. The Administrator also provided an invoice from Cooling & Heating Repair showing the AC unit was repaired on 8/20/20. Based on the information gathered, there is insufficient evidence to support this allegation to be true.

Allegation: Facility failed to provide a comfortable temperature for the residents. The details of this allegation states that facility failed to provide a comfortable temperature for the residents in care. During the night the temperature usually drops below 50 degrees and it’s freezing cold. (Allegation was reported to Community Care Licensing on 2/11/21).
Based on interviews conducted, the statements obtained did not corroborate with the allegation. Staff and clients interviewed did not present concerns of the facility temperature being uncomfortable and/or too cold for the clients in care. Statements obtained denied the facility being freezing cold. Based on the information gathered, there is insufficient evidence to support this allegation to be true.

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 allegations are unsubstantiated. An exit interview was conducted and a copy of this report was provided to the Direct Support Professional..
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2