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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320071
Report Date: 05/03/2023
Date Signed: 06/12/2023 01:21:12 PM

Document Has Been Signed on 06/12/2023 01:21 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:INCLUSION SPECIALIZED PROGRAMS,LLC - CONDONFACILITY NUMBER:
198320071
ADMINISTRATOR:MACIAS, BLANCAFACILITY TYPE:
738
ADDRESS:10521 CONDON AVETELEPHONE:
(562) 968-0605
CITY:INGLEWOODSTATE: CAZIP CODE:
90304
CAPACITY: 4CENSUS: DATE:
05/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Osameda OghideTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Felisa Shirley arrived unannounced to conduct an Annual Required – 1 Year Inspection and met with Osamede Oghide, Lead. LPA disclosed the purpose of the inspection and was granted entry into facility. The current census is 4.


Facility is a single-story family home located in a residential neighborhood which consisted of the following: Living room, dining room, kitchen, (4) bedrooms, two (2) bathrooms, office, family/TV room, laundry room, detached car garage and outdoor shaded patio area. There is two (2) exits doors located at the front entrance door and hallway. Washer/Dryer installed. The landscaping is nicely manicured in the front and backyard.

There is one client per bedroom. Bedrooms are equipped with a full size-bed, chest of drawers, lamp, chair and nightstand. Bathrooms have working toilets, wash basin and showers. Hot water was tested in the Kitchen and bathrooms, water measured at 114.3 F.

Emergency numbers are posted and readily available for review in the dining area and office. The facility has a landline telephone located in the office area. The home has two (2) fully charged fire extinguishers located in the kitchen and hallway. Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked drawer in the kitchen. The facility has operable hardwired and battery backup smoke and carbon monoxide detectors located in all common areas: Living room, kitchen, dining room, laundry room, bathrooms, hallways and in bedrooms #1, #2, #3 and #4.

Con'd on 809C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS,LLC - CONDON
FACILITY NUMBER: 198320071
VISIT DATE: 05/03/2023
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Stove burners (electric), oven, microwave and refrigerator in the kitchen. The residence is equipped with central heating and fans. The water heater is located in the garage. Cleaning supplies and toxins are stored in a separate locked cabinet in the kitchen cabinet only accessible to staff. Designated centrally stored medications are stored in a locked cabinet in the laundry room. Sufficient bandages, one (1) tweezer, thermometer, and scissors. First aid kit is fully stocked with manual.

No deficiencies were cited at this time.

An exit interview was conducted and a copy of this report was left with Osamede Oghide, whose signature on these forms confirm receipt of these documents.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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