198320073-10-24-2024-11-AS-SCIS-DB2VHA-20241115152650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320073
Report Date: 10/24/2024
Date Signed: 10/24/2024 05:15:47 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/02/2024 and conducted by Evaluator Troy Watson

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240102172214

FACILITY NAME:	INCLUSION SPECIALIZED PROGRAMS,LLC-WEST 130TH		FACILITY NUMBER:	198320073
ADMINISTRATOR:	COOK, DAVID		FACILITY TYPE:	738
ADDRESS:	4442 W. 130TH ST		TELEPHONE:	(626) 476-2341
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	4	CENSUS: 2	DATE:	10/24/2024
		UNANNOUNCED	TIME BEGAN:	05:06 PM
MET WITH:	Adedapo Ajibade - Lead Staff		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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1.Resident engaged in inapproproiate sexual behaviors due to staff neglect
2.Staff allowed resident to have access to inappropriate items,
3.Staff inappropriately persuaded resident ..

INVESTIGATION FINDINGS:

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On 10/24/2024 Licensing Program Analyst (LPA) Troy Watson conducted an unannounced subsequent complaint visit. Upon arrival at the facility. LPA Watson met with Adedapo Ajibade and explained the purpose of today’s visit is to deliver findings for the allegations listed above. LPA was granted access to facility grounds.
The investigation consisted of the following: During the investigation. Interviews were conducted with staff members1-6 (S1-S6) and Client 1 (C1). The department asked questions pertinent to the nature of the complaint. The department toured the 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 visits. The department requested and reviewed client 1's (C1) records and requested copies of supporting documents.
Investigation revealed the following:

CONTINUE REPORT TO LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

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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Control Number 11-AS-20240102172214

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS,LLC-WEST 130TH	FACILITY NUMBER: 198320073
	VISIT DATE: 10/24/2024

NARRATIVE

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Allegation #1: The client engaged in inappropriate sexual behaviors due to staff neglect.
The department conducted interviews with the facility staff members 1-6 (S1-S6), client 1 (C1), Witness 1 and Witness W2,Westside Regional Center staff. All reported C1 has a history of fabricating, lying, and being untruthful. Client and staff records, enforcement reports, facility training, and disciplinary action forms about the facility staff were requested and reviewed. The client has been diagnosed with attention-seeking disorders and has a history of making false allegations. There were no witnesses to corroborate the allegation made. S1-S6 noted that C1 became jealous after the resident was informed the staff had a girlfriend or had communicated with a female relative of C1. Hawthorne Police Department completed a police report DR24-0000111 and stated no sexual assault exam was conducted. S1-S6 denied the allegation. The department investigation did not provide sufficient evidence to substantiate the allegations.

Allegation #2: Staff allowed the client to have access to inappropriate items.
The department conducted interviews with the facility staff members 1-6 (S1-S6) and Client 1 (C1). S1-S6 stated that the client does not initial or sign off on the MARs, and staff do not allow the client to have access to the MARs. C1 stated that she does not have access to the client's medications, staff dispenses the medication, signs off on the medication, and dispenses the medications according to the doctor's order. S1-S6 and C1 stated that the client does not have the gate code. S1-S6 and C1 denied the allegation. The department reviewed facilities Medication administration records and found them to be signed for by staff. The department investigation did not provide sufficient evidence to substantiate the allegations.

Allegation #3: Staff inappropriately persuaded client.
The department conducted interviews, with the facility staff members 1-6 (S1-S6), and Client 1 (C1). S1-S6 also stated that the administrator did not take the client on an outing to influence or dissuade the client from making any statements. C1 stated staff never inappropriately persuaded the client. S1-S6 and C1 denied the allegation. Facility records, enforcement reports, and training documents were reviewed as part of the investigation. The department investigation did not provide sufficient evidence to substantiate 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. An exit interview was conducted, and a copy of this report was left with

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

LIC9099 (FAS) - (06/04)

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