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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602290
Report Date: 08/03/2024
Date Signed: 08/03/2024 01:46:00 PM

Document Has Been Signed on 08/03/2024 01:46 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 - WEST 139THFACILITY NUMBER:
198602290
ADMINISTRATOR/
DIRECTOR:		OSAMEDE OGHIDEFACILITY TYPE:
735
ADDRESS:4835 W 139TH STTELEPHONE:
(565) 447-0991
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 3CENSUS: 2DATE:
08/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:09 AM
MET WITH:Administrator Osamede OghideTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 08/03/2024, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator Osamede Oghide. LPA explained the purpose of the visit and was accompanied by the Administrator inside and outside the facility during this inspection. The facility is licensed to operate and care for three (3) non-ambulatory adults (ages 18 through 59).

The facility is a single-story home located in a residential neighborhood. It consists of the following: three (3) bedrooms, two (2) bathrooms, living area/family room, dining area, kitchen, outdoor recreational activity area and outside patio.

Outside grounds were toured and no bodies of water were observed. There are no security bars or weapons on the premises.

Clients’ bedrooms were checked. Adequate lighting, plenty of dresser and closet space observed. Walls were clean and in good condition. Bathroom toilets and water faucets worked properly. Adequate lighting and toiletries accessible to clients. LPA Cloyd tested hot water temperature and it measured at 111.7 degrees Fahrenheit. This facility provides clients with hygiene products such as nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb. Continue to LIC809-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2024
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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLC - WEST 139TH
FACILITY NUMBER: 198602290
VISIT DATE: 08/03/2024
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LPA observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days.

LPA observed that Medications were safe, locked and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Smoke and carbon monoxide detectors were in compliance and operational.

Five (5) staff records were reviewed, 5 out of 5 staff records had required criminal record clearances or criminal record exemptions.

Two (2) client records were reviewed and, 2 out of 2 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. Two client medications were reviewed.

No deficiencies cited.

Technical assistance provided and a copy of this report was discussed and left with the Administrator Osamede Oghide.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2024
LIC809 (FAS) - (06/04)
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