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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320073
Report Date: 12/27/2024
Date Signed: 12/27/2024 11:00:19 AM

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
12/23/2024 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20241223151806
FACILITY NAME:INCLUSION SPECIALIZED PROGRAMS,LLC-WEST 130THFACILITY NUMBER:
198320073
ADMINISTRATOR:COOK, DAVIDFACILITY TYPE:
738
ADDRESS:4442 W. 130TH STTELEPHONE:
(626) 476-2341
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:4CENSUS: 2DATE:
12/27/2024
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Staff - Tony MadukaTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Staff do not intervene in resident on resident altercations
INVESTIGATION FINDINGS:
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On 12/27/2024, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted an unannounced complaint visit at this facility. CCLD staff was greeted by Staff, Tony Maduka.

The investigation consisted of the following:
The department interviewed 5 staff and 2 clients, toured the facility, and reviewed Staff Roster and Client Roster.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
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 2
Control Number 11-AS-20241223151806
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-WEST 130TH
FACILITY NUMBER: 198320073
VISIT DATE: 12/27/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation “Staff do not intervene in resident-on-resident altercations”, it is being alleged that staff do not intervene in client-on-client physical altercations. Interviews conducted revealed the following: 2 out of 2 residents denied the allegation and 5 out of 5 staff denied the allegation. The departments observations revealed the following: On 12/27/2024, CCLD staff observed a ratio of 4 staff to 1 client. The facility has 4 bedrooms with a census of 2 clients. One client’s bedroom is located at the front of the house with their own bathroom, alongside the main living room, kitchen and TV; while the second client’s bedroom is located in the back of the house, with their own bathroom and a personal living room. Records reviewed revealed the following: No recent unusual incident reports indicating that there was a client-on-client altercation. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

No citations were issued.

An exit interview was conducted, and a copy of this report was left with Staff, Tony Maduka.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2