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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208779
Report Date: 08/22/2024
Date Signed: 08/23/2024 02:08:41 PM

Document Has Been Signed on 08/23/2024 02:08 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:AMBITIONS - SUMTER COURTFACILITY NUMBER:
547208779
ADMINISTRATOR/
DIRECTOR:		ISAM, TAMMYFACILITY TYPE:
735
ADDRESS:1020 N SUMTER CTTELEPHONE:
(559) 739-7974
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 3DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Administrator (Admin) Jessica Mata; Client Care Coordinator (C3) Jaylyn JohnsonTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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An Annual visit was conducted by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Administrator (Admin) Jessica Mata & Client Care Coordinator (3C) Jaylyn Johnson. LPA introduced self, provided business card, stated purpose of visit, & was allowed to proceed.

Physical plant toured. Dining & living rooms sufficiently furnished with adequate lighting. Kitchen appeared to be clean & maintained appropriately. Sufficient food. Freezer/Refrigerator appeared to be clean & sufficiently maintained to allow food to be kept at appropriate temperatures. Resident bedrooms toured. Bedrooms sufficiently furnished with adequate lighting. Required linens on beds along with sufficiently supply of linens such as sheets, towels, etc. Resident bathrooms appeared to be clean with no unpleasant odors. Fixtures operational. Hot water measured @ 108 degrees F.

Laundry room toured. Hazardous chemicals &/or cleansers inaccessible. Entries & hallways observe to be clear & free of obstruction. No hazards observed in backyard areas. Medications organized & locked. Client & staff files appropriately maintained. Smoke & Carbon Monoxide detectors operational. Fire extinguisher service date: 12/1/24.

Exit interview conducted with 3C. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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