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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547208779
Report Date: 12/26/2024
Date Signed: 12/26/2024 04:48:49 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, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2024 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20241220151147
FACILITY NAME:AMBITIONS - SUMTER COURTFACILITY NUMBER:
547208779
ADMINISTRATOR:ISAM, TAMMYFACILITY TYPE:
735
ADDRESS:1020 N SUMTER CTTELEPHONE:
(559) 739-7974
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:4CENSUS: 2DATE:
12/26/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Direct Service Professional (DSP) Camelle Cortez; by telephone: Client Care Coordinator (C3) Jaylyn Johnson;TIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
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5
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8
9
Staff are not adequately supervising residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
An unannounced Complaint visit was conducted on the date indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Direct Service Professional (DSP) Camelle Cortez. LPA introduced self, provided business card, stated purpose of visit, & was allowed entry. According to DSP Client Care Coordinator (C3) Jaylyn Johnson & Administrator (Admin) Jessica Mata were out with clients from the Mae Carden home @ doctor appointments. LPA called & spoke by telephone with Client Care Coordinator (C3) Jaylyn Johnson. LPA stated purpose of visit & shared items DSP was pulling for review during this visit. LPA to call CCC back later during this visit with any questions &/or to discuss allegation. LPA joined by CCC & Admin later during this visit.

Reviewed Individual Program Plan (IPP) & Individual Service Plan (ISP) for all clients in care. IPP & ISP do not dictate required ratio, i.e., 1 on 1; for either client per Central Valley Regional Center (CVRC). Medical assessments reviewed. No indication of need for additional supervision.

Facility staffing roster reviewed for past & present scheduling. Staffing appears to be appropriate to meet clients needs at all times. No indications &/or incidents that suggest additional staffing as currently staffed.

The Department has investigated the above allegation & determined it to be Unsubstantiated.

Exit interview conducted with CCC & Admin. Report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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