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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602097
Report Date: 03/20/2025
Date Signed: 03/20/2025 01:26:58 PM

Document Has Been Signed on 03/20/2025 01:26 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:INCLUSION SPECIALIZED PROGRAMS LLC - MANORFACILITY NUMBER:
198602097
ADMINISTRATOR/
DIRECTOR:		OSAMEDE OGHIDEFACILITY TYPE:
735
ADDRESS:13916 MANOR DRTELEPHONE:
(424) 374-4165
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 3CENSUS: 2DATE:
03/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Assistant Director - Blanca Mecias.TIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On 03/20/2025 around 9:20 AM, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with House Manager, Anaiya Kelly and was granted entrance into the facility. LPA explained the purpose of the visit and was accompanied by the House Manager inside and outside the facility during this inspection.

This facility is licensed to serve 3 non-ambulatory adults ages 18 to 59 years old

A total of 2 clients are currently residing in this facility.

The Annual Licensing Fees are current.

Facility Layout: The facility is a one-story house located in a residential street. The home consists of 3 client bedrooms, 2 full bathrooms, 1 great room consist of the kitchen, dining room area, living room area, and an office space, and 1 backyard patio area with a gazebo.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 - MANOR
FACILITY NUMBER: 198602097
VISIT DATE: 03/20/2025
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Outside Grounds: were toured no bodies of water were observed, walkways around the home were clear of hazards, and there are no security bars or weapons on the premises.

Kitchen Area/Facility Food: The facility has supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept inaccessible to clients in care. There is fire extinguisher in the kitchen area, and it was last serviced on 12/24/2024. There is a land line telephone on the kitchen counter.

Living Room Area: There is a tv, video games, couches and sofa chairs for clients to sit at.

Client Bedrooms: 2 out of 3 client bedrooms were toured. There is adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition.

Bathrooms: Toilets, showers, and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to clients. Water temperature measured 115 Fahrenheit.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 - MANOR
FACILITY NUMBER: 198602097
VISIT DATE: 03/20/2025
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Medications: were inaccessible to clients in care. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. 2 out of 2 Medication Administration Records (MARs) were reviewed and they were current and up to date.

Garage: was toured. Backstock of cleaning supplies is stored in the garage.

Miscellaneous: Documents are posted as mandated. Last Quarterly Disaster Drill was conducted on 3/4/2025. First aid kit is fully stocked with manual. There is a landline telephone and a videoconferencing device in the office area.

5 staff records were reviewed, 5 out of 5 staff records had required documentation.

2 client records were reviewed and, 2 out of 2 client records had required documentation.

A technical advisor is being provided regarding keeping Personal and Incidental (P&I) records up to date and current and updating the Emergency Disaster Plan.

No deficiencies are being cited based observation and record review in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted, and a copy of this report was left with the Assistant Director, Blanca Mecias.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
LIC809 (FAS) - (06/04)
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