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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004223
Report Date: 11/25/2024
Date Signed: 11/25/2024 10:07:25 AM

Document Has Been Signed on 11/25/2024 10:07 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: 4DATE:
11/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:36 AM
MET WITH:Stephanie SmithTIME VISIT/
INSPECTION COMPLETED:
09:37 AM
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On 11/25/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Case Management visit at Ambitions - Albury facility. The purpose of today’s visit is to serve an ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM FACILITY for staff #1. LPA met with administrator Stephanie Smith in person. LPA explained the purpose of today’s visit.

An investigation conducted by the California Department of Social Services determined that staff #1 violated California Code of Regulations Title 22 for the client's personal rights. Government Code 11522 was also issued, informing the licensee that an excluded person may petition for reinstatement to the Department one year after the effective date of the exclusion order. LPA delivered copies of the immediate exclusion letters for the following facility to the administrator, Stephanie Smith.

Staff #1 (S1) was not present at the facility at the time of the visit and was provided with the Immediate Exclusion Order letter and Government Code 11522. The administrator, Stephanie Smith was read the Immediate Exclusion from Facility Order and stated she understood the immediate exclusion order and that she understands the mentioned staff is not allowed to be physically present in the facility.

An exit interview was conducted with Stephanie Smith and copies of Order to Licensee/Facility of Immediate Exclusion from Facility and Government Code 11522 were provided. The report was signed by administrator Administrator Stephanie Smith.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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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