198320071-10-1-2024-11-AS-RORN-DA3L7Y-20241015083103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320071
Report Date: 09/26/2024
Date Signed: 10/01/2024 01:09:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20230720115205

FACILITY NAME:	INCLUSION SPECIALIZED PROGRAMS,LLC - CONDON		FACILITY NUMBER:	198320071
ADMINISTRATOR:	MACIAS, BLANCA		FACILITY TYPE:	738
ADDRESS:	10521 CONDON AVE		TELEPHONE:	(562) 968-0605
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90304
CAPACITY:	4	CENSUS: 3	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	08:07 AM
MET WITH:	Mujib Muhali and Judex Nkwocha		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Client sustained multiple unexplained injuries while in care of staff
Staff improperly restrained client resulting in bruising

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Thursday, September 26, 2024. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with staff members Mujib Muhali and Judex Nkwocha. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed staff members 1-5 (S1-S5) and residents. Client 1 (C1) was not available for an interview and no longer resides at the facility. LPA also interviews clients 2-3 (C2-C3). LPA Bunker asked questions relevant to the nature of the complaint. During the course of the investigation, LPA Bunker toured the entire facility buildings and grounds to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during the visit on July 21, 2023, or September 26, 2024.
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 11-AS-20230720115205

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS,LLC - CONDON	FACILITY NUMBER: 198320071
	VISIT DATE: 09/26/2024

NARRATIVE

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Continued LIC9099-C page 2

S1-S5 stated that C1 did not sustain multiple unexplained injuries while in care. S1-S5 stated that C1 has a history of striking their own biceps, and stomach with C1's hands and tearing clothing. S1-S5 also stated that no physical restraints were used on C1. C2 stated that C1 has self-abusive behaviors and that staff did not harm or injure C1. C3 who was not a client at the facility at the time, mentioned that C1 attended the same Day Program and that C1 only hits individuals he dislikes.

LPA Bunker requested, observed, and conducted a thorough review of the client's file folder. LPA Bunker requested copies of the following supporting documents including the following: Physician's report, medical records, admission agreement, identification and emergency information, contact information, medication list, medication log, medication administration records (MARs), medical assessment, consent forms, release of resident medical information, special incident reports, individual emergency intervention plan (IEP), individual program plan (IPP), Westside Regional Center Monthly QBMP Audit records, appraisal/needs and services plan.

Allegation #1 Client sustained multiple unexplained injuries while in the care of staff
S1-S5 interviewed stated C1 did not sustain multiple unexplained injuries while in the care of staff. S1-S5 stated the facility is a crisis home that requires a higher level of supervision and care for clients. S1-S5 stated staff does a complete body check on C1 before he leaves for the Day Program and when C1 returns home to the facility no bruises or injuries were observed. S1-S5 stated that C1 has a history of sustaining bruises and scratches on the body. S1-S5 denied the allegation.

Allegation #2 Staff improperly restrained client resulting in bruising
S1-S5 interviewed stated staff did not improperly restrain the client resulting in bruising. S1-S5 stated the facility is a crisis home that requires a higher level of supervision and care for clients. S1-S5 stated that C1 would strike their own biceps, and stomach, with the hands and tear clothing. S1-S5 stated C1 was never physical restraint by staff resulting in bruising. S1-S5 denied the allegation.

See continued LIC9099-C page 3

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230720115205

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS,LLC - CONDON	FACILITY NUMBER: 198320071
	VISIT DATE: 09/26/2024

NARRATIVE

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Continued LIC9099-C page 3

Investigation revealed the following: Interviews with staff 1-5 (S1-S5) all stated that C1 has a documented history of self-abusive behavior, which is noted in the client file. Records reviewed show that C1 has a history of sustaining bruises and scratches to the body. S1-S5 stated that staff conduct complete body checks before and after C1's departure from the facility. They stated that C1 had no bruises or injuries on the body when C1 left for the Day Program. S1-S5 also stated that no physical restraints were used on C1. S1-S5 stated all incidents are documented and reported to all the appropriate agencies in a timely manner. IB Investigator Sonia Sandoval completed the investigation and found the allegations unsubstantiated. S1-S5 and C2 denied the allegations.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.

There were no deficiencies cited.

A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to staff Judex Nkwocha.

An exit interview was conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

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