<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601942
Report Date: 09/24/2024
Date Signed: 09/24/2024 02:48:02 PM

Document Has Been Signed on 09/24/2024 02:48 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:INCLUSION SPECIALIZED PROGRAMS LLC - AGRAFACILITY NUMBER:
198601942
ADMINISTRATOR/
DIRECTOR:
KELLY HITCHENSFACILITY TYPE:
735
ADDRESS:5528 AGRA STTELEPHONE:
(562) 447-0991
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY: 4CENSUS: 3DATE:
09/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:House Manager Louneesha YoungTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by House Manager Louneesha Young and explained the reason for the visit.
The purpose of the visit is to complete the required inspection.
LPA toured the facility along with House Manager Louneesha Young today 09/24/2024 at 12:45 PM and the following was observed:
Facility contains 4 Client Bedrooms and 2 Client Bathrooms, dining room, living room, and TV room.
Annual Inspection includes the following Domains:
Infection Control, Physical Plant and Environmental Safety, Operational Requirements, Staffing, Personnel Records-Training, Client Rights- Information, Client records- Incident Reports, Food Service, Health related Services, Incidental Medical Services, and Disaster Preparedness.
Interview was conducted with 1 staff and 1 client. 3 clients were at Day Program. 3 client files were reviewed and 5 staff files were reviewed. All staff were cleared and associated.
Medication was administered per physician's directions.
Signage for hand washing and proper sanitizing were posted. Staff have been trained in hand washing.
Licensee maintained an individual admission agreement for each client.
Fire Clearance has been maintained.
Facility had sufficient supply of 2 day perishable and 7 day non-perishables meeting regulations.
Each client has personal rights free from corporal or unusual punishment, infliction of pain, humiliation, ridicule, coercion, threats, mental abuse, or other actions of a punitive nature.
There is an adequate number of direct care staff to support each resident's physical, social, emotional safety and health care needs as identified in his/her current appraisal.
Hot water temperature measured between 105-120 F. meeting Title 22 Regulations.
Facility has a sufficient supply of PPE.

No deficiencies. Exit interview conducted.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1