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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004223
Report Date: 09/09/2024
Date Signed: 09/12/2024 08:00:10 AM

Document Has Been Signed on 09/12/2024 08:00 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 - ALBURY AVENUEFACILITY NUMBER:
306004223
ADMINISTRATOR/
DIRECTOR:		SMITH, STEPHNIEFACILITY TYPE:
735
ADDRESS:3836 ALBURY AVETELEPHONE:
(562) 982-4128
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 3CENSUS: 3DATE:
09/09/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Stephanie SmithTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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On 09/09/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Case Management visit at this facility. LPA was not greeted at the door by anyone. LPA contacted Program Director Stephanie Smith and explained the inspection visit is associated with an incident on 02/15/24 and a case management visit on 02/22/24.

On 02/22/24, an interview with Stephanie Smith Program Director reported an incident concerning client #1 (C1) and staff #1 (S1) involving physical assault. The Department interviewed staff #2 (S2) who claimed to have been a witness to the incident involving (C1) & (S1) and confirmed that a physical assault had occurred. Due to an ongoing investigation, staff #1 (S1) was not available for an interview.

LPA Dabuet inquired about what had transpired from the internal investigation and Harbor Regional Center's investigation. The facility and Harbor Regional Center substantiated the investigation, according to Smith. Ambitions have terminated the employee's employment.

An exit interview was conducted with Stephanie Smith by telephone and a copy of the report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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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