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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004223
Report Date: 02/22/2024
Date Signed: 02/22/2024 01:59:42 PM

Document Has Been Signed on 02/22/2024 01:59 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 - ALBURY AVENUEFACILITY NUMBER:
306004223
ADMINISTRATOR:SMITH, STEPHNIEFACILITY TYPE:
735
ADDRESS:3836 ALBURY AVETELEPHONE:
(562) 982-4128
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 3CENSUS: 3DATE:
02/22/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Stephanie Smith TIME COMPLETED:
11:59 PM
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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 Stephanie Smith 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, Program Manager China Hampton reported an incident concerning client #1 (C1) and staff #1 (S1) involving physical assault. The Department interviewed administrator #1 (A1) Stephanie Smith regarding the incident involving (C1) and (S1). Interviews with clients between 11:10 am through 11:30 am clients #1-#3 (C1-C3). The interview with staff #2 (S2) took place between 11:30 and 11:40 a.m.

During the visit, the Department observed Long Beach Police Department #240009264 was at the facility conducting interviews with staff.

The entire facility was inspected for health and safety, and service records for (C1) and personnel records for (S1) were provided via email to (LPA) Ernand Dabuet.

An exit interview conducted with Stephanie Smith 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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