raw_content:
Narrative:
During the period of 01/15/2026 and 03/30/2026 confidential interviews were conducted with six individuals (RP, C1, S1, S2, S3, CSW) Based on LPA observations during three visits conducted on January 15, 2026, March 3, 2026, and April 1, 2026, no malodorous odors were detected within the residence or in the vehicle used to transport residents. During the visit on January 15, 2026, the LPA detected the odor of marijuana while outside on the street; the source appeared consistent with a neighboring residence rather than the facility. Additionally, during interviews conducted by the LPA, five out of six interviewees stated they had not smelled marijuana or any other unusual odor within the home. There is no evidence to support that smoking occurs within the residence. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. 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. No title 22 regulations were cited during today's inspection. Exit interview conducted and a copy of this report was left with Annalyn Artadi, Licensee.

Investigation Findings:
13Licensing Program Analyst (LPA) Maie conducted an unannounced complaint inspection with the above facility on 4/14/2026 at 1pm and met with Annalyn Artadi, Licensee (LIC) The purpose of the inspection was to deliver complaint findings for the above allegations. On 1/15/26 at 12:30 pm Licensing Program Analyst (LPA), Maie Soliman, arrived unannounced at the agency for the purpose of initiating a complaint investigation related to the above allegation. LPA met with Annalyn Artadi, Administrator. During the course of the investigation, the following documents were gathered and reviewed: LPA requested the following documents for review: Admission agreement, Face Sheet, Needs and Services Plan, Daily Notes, Incident Reports and staff work schedule. No concerns noted. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Maie Soliman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: IHEART LIVES INCFACILITY NUMBER: VISIT DATE: 04/14/2026

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:


state: CA

facility_name: INCLUSION SPECIALIZED PROGRAM-HIGHLAND

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
RP stated she arrived at work and observed that C1 had numerous bruises and scratches on them. RP specifically saw a large bruise and scratches to the back, bruises and scratches on the right elbow, and bruising around the right eye. Due to C1 being nonverbal, RP could not question C1 about the injuries. However, C2 informed RP that C2 observed C1 was in the back yard and S1 physically grabbed and drug C1 on the ground over cement stairs. C2 reported that S1 treats C1 "bad" and always tells C1 to go to their room and S1 causes C1's behaviors. RP stated that C1 does at times inflict self-injury but usually does so by biting and the injuries that RP observed did not appear to be self-inflicted. S2 stated they did not know how C1 sustained the large bruise on C1's back. C1's bio-mother stated she had never seen any bruising on C1's face before and is concerned with the bruising. S4 stated that they believed that C2 was telling the truth and witnessed S2 causing the injuries to C1 because C2 was consistent in informing the staff and Administrator of the incident. The Doctor reported that the scrapes and bruising could be caused by C1 being dragged on the concrete. S2 reported they were was present with reporting party when the bruising was discovered on C1's body. S2 stated the protocol for client behavior is "no hands on". The staff are trained to block and redirect the clients. S1 denied ever dragging or going "hands on" with C1. S3 stated they did not see C1 fall on the ground or have any behaviors and does not know how the injury happened. Administrator sent IB investigator an audio recording of the phone call between S4, C2, Administrator where C2 confirms that S1 dragged C1 up to the steps" and kicked C1. Based on IB interviews with Administrator, Audio recording, staff and photos the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. The facility is cited for violation of California Code of Regulations, Title 22, Division Six, Regulation Personal Rights- 84072(D)(11) To be free from physical, sexual, emotional, or other abuse, and corporal punishment. Refer to 9099D for Title 22 deficiencies cited. Exit interview was conducted with agency Social Worker **Confidential names list provided** **Appeal rights given***

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

report_type: Complaint Investigation

met_with: Momo Duoa, Administrator

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
During LPA's interview with Administrator, she explained to LPA that there were new issues with C1's insurance which inhibited the facility's ability to schedule an appointment with psychiatry to establish care and refill prescriptions for C1. Administrator made made many follow-up calls and attained different records to attempt to get the issues resolved, to no avail. C1's medications ran out on 4/29/2024, and on 5/1/ Administrator obtained a 10-Day emergency supply. The Administrator informed LPA that they did not obtain this sooner as they thought the coverage would go through before that. Afterwards, the issue was resolved and an appointment was scheduled for 5/23/2024. However, with the knowledge that C1's appointment was not until 5/23/2023, on 5/12/2024 after the 10-day emergency supply of medication ran out, C1 was again without medication until 5/15/2024. An emergency supply was obtained on 5/16/2024 and C1 resumed medications as normal. While the Administrator was diligent in following up with the relevant parties in completing all tasks required to attain a doctor's appointment to establish care for C1, and to then attain prescribed medications, there were two lapses in medications being provided to C1 in which emergency medication supplies were not attained timely, resulting in a total of six days of missed medication. Additionally, during LPA's inspection on 6/20/2024, LPA conducted a review of C1's medications. LPA found that for two medications (M1 and M2), there were 20 pills in the bottle, 30 originally prescribed, and eight marked as taken, leaving 2 pills unaccounted for for both. Administrator checked with the Facility Manager and the Medication Administration Records added up correctly, however there was no explanation for four the unaccounted for pills. CCL and the authorized representative did not receive an incident report for both missed medication events (4/29/2024 and 5/12/2024) until 6/12/2024, after the Regional Center Service Coordinator brought to the Administrator's attention that an incident report needed to be submitted. The Administrator informed LPA that with everything going on she failed to create and send the incident reports as required. Based on LPA's observations and conducted interviews, the preponderance of the evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter Sections 80078(a) and 80061(b)(1)(E)&(f), are being cited on the attached LIC 9099D. An exit interview was conducted with FM and a copy of this report, confidential names list, and appeal rights were provided to her.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess made an unannouced complaint investigation inspection at the facility and met with Facility Manager Catalina Correa, who assisted with the inspection. LPA investigated this complaint by reviewing client's facility Incident Report related to this complaint, Medication Administration Records (MARs), Individual Placement Plan (IPP), JV220 and JV223 forms, emergency medical consent form and medication administration consent form dated 12/21/2023, medical consent form from the Regional Center dated 4/16/2024, physical medications at the facility, emails, ER discharge paperwork, and Admission Agreement. LPA conducted interviews with the Administrator and the client (C1) on 6/20/2024 and 6/28/2024. During LPA's interview with the client, C1, they informed LPA that they believed they missed medication due to the facility not receiving timely permission from their legal guardian to have it. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Alyssa M Burgess LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: INCLUSION SPECIALIZED PROGRAM-HIGHLANDFACILITY NUMBER: VISIT DATE: 10/18/2024

met_with: Catalina Correa


summary: Facility Evaluation

raw_content:
Narrative:
This documented was Amended, the Case Management was conducted on 5/18/21. Licensing Program Analyst, (LPA) Ignacia Villapudua-Soto arrived at the facility to conduct a case management inspection on 05/18/21 at 3:35. During the inspection, LPA met with Administrator Momo Dua and discussed the incident reports. . Community Care Licensing (CCL) received the following incident reports pertaining to C1. as follows: 3/17/21, incident reports, C1 engaged in noncompliance and tantrum behaviors, staff went to the restroom leaving client outside in the patio, during that time, the client attempted to climb the fence: Incident 4/14/21, C1 become confrontational with roommate and took the facility keys and went to his room. C1 continued his non-compliance and scratched the staff; 04/15/21 incident, C1 began to escalate due to wanted to play games. C1 got the house binders and took them outside. C1 removed documents and ripped them up. The staff tired to redirect him. C1 grabbed the printer and threw it on the floor and broke it. C1 went to the neighbor's fence and grabbed a brick and threw it at the facility van breaking the windshield; 5/10/21 incident: C1 become noncompliant grabbed the daily binders and other objects. Throwing them around the house. Administrator arrived at the facility to provide support to the team. 05/13/21 incident: C1 engaged in noncompliance behaviors and property destruction. C1 swing the refrigerator door open , ripping it off the hinges, destroying containers and the shelves on the door. Administrator stated he is working closely with North Bay Regional Center, Diana Montes for additional support and funding for additional staff for the facility. Administrator stated he also working the Regional office where the facility is going to be remodeling the home for a safer environment. Administrator stated, he is in the process of hiring more staff for the facility. LPA advised Administrator to follow up with LPA with hiring more staff and sharing the plans for the remodeling of the home. LPA is requesting to follow up with the regional center for services for C1. Administrator will follow up with LPA regarding the a plan regarding a safety plan for C1 and Administrator's will follow with the Regional Center regarding additional services for C1. No citations will be given at this time. Exit interview was conducted with Administrator. Administrator will sign and email the signed LIC 809.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Momo Dua, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Ignacia Villapudua-Soto and Senior Service Coordinator (SC). North Bay Regional Center, Diana Montes arrived at the facility to conduct a joint case management on 05/18/21 at 2: PM. During the inspection, LPA and SC met with Administrator, Momo Dua and discussed the incident. Community Care Licensing (CCL) received an incident report dated May 14, 2021. It was reported that C1 engaged in tantrum behavior, aggression towards staff and self-inflicted injuries due to his behaviors. (Refer to confidential name's list, LIC 811) C1 asked for his IPAD but staff advised C1 that it wasn't time to play with IPAD. C1 proceeded to go to another staff and ask for the IPAD. The staff again confirmed that it wasn't time for his IPAD. C1 become assaultive to staff and fell to the floor and attempted to kick staff. Staff immediately utilized verbal prompts to redirect C1 to the backyard of the facility for activities. C1 continued to actively engage in physical aggression towards staff. Support staff evaded, removing furniture and other items from within the C1's vicinity. Support Staff left the immediate area providing C1 with space and followed the BIP (planned, ignoring/extinction). C1 was in the living room engaging in tantrum behaviors of kicking the floor and biting his hand/arm (laying on his back). Staff continued to provide supervision with no verbal prompts/stimulus toward the consumer. C1 abruptly turned his body 90 degree, and kicked the glass panel of the fireplace and the glass broke and cut C1. Staff utilized first Aid training/protocols to apply pressure to the wound. C1 foot was bleeding profusely. Staff transported C1 to Kaiser Vacaville. Administrator met staff in the hospital lobby to offer support. Administrator assisted nurses and doctors to try to keep C1 calm. C1 become aggressive behaviors with nurses and Administrator. C1 received 3 sutures , and was assessed for 2.5 hours before being released to Administrator. Administrator stated the facility will continue to provide adequate support and redirection to C1 and assure that client is safe and a safety plan in process. Administrator stated he is in communication with the North Bay Regional Center for additional support and for additional staff for this facility. No deficiencies were cited on today's date. Exit interview conducted and a copy of this report was emailed to Administrator, Momo Dua.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, Ignacia Villapudua-Soto arrived at the above group home to conduct unannounced ANNUAL/REQUIRED of the facility on 02/16/22 at 3: PM. LPA met with Administrator, Ileya Silva on today's date and explained the purpose of the visit. LPA Villapudua-Soto and the Administrator conducted a joint inspection of the interior and exterior of the group home. The home is a three bedroom, two bath home. The home is licensed for a capacity of 3 ambulatory clients. The clients are developmentally disabled clients. Currently the group home has one client in care. LPA Villapudua-Soto conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The front and back yard were free of clutter; and the passage ways and egress were unobstructed. No potentially hazardous items or areas were observed. Cleaning supplies and extra hygiene items are located in a locked closet at the end of the hallway. Extra bed linens, towels and washcloths are located in the hallway. Medications are stored in a locked cabinet near the kitchen. A fully stocked first aide kit was observed in the medication cabinet. The kitchen was observed to be stocked with ample perishable and non-perishable foods meeting the requirement of two days of perishable and seven days of non-perishable foods. The facility has a posted menu on the fridge. Under the kitchen sink the cabinet is locked with knives and other sharp items. The living room furniture was observed to be in good repair. The living room allowed enough space for clients to engage in indoor activities. The front yard is well maintained. The backyard is concrete. There is a patio table and chairs available to clients. However, the patio table was not in good repair, therefore the Administrator will be disposing of the patio table. LPA observed a locked shed with maintenance supplies in the backyard. Hot water temperatures was tested, however, Administrator will obtain services from a Professional Plumber due to the 1st bathroom shower not regulating hot water. The Administrator will be emailing LPA a copy of the Plumber's receipt that the issue has been addressed. . LPA Villapudua-Soto and Administrator conducted a joint inspection of the facility vehicle/van. The van has the proper car insurance and first Aid and is in good repair. The home has a disaster plan, facility sketch and personal rights posting in the home. The facility has two Carbon Monoxide detector and fire detectors. LPA will return to complete the required Annual/Required inspection at a later date.

visit_type: Annual

met_with: Ileya Silva, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Ignacia Villapudua-Soto arrived at the above Group Home to conduct the continued Required ANNUAL/RANDOM continuation inspection at this facility on 03/8/22 at 12: PM. LPA met with Administrator, Vanessa Baldwin regarding the Continuation of the Annual/Random inspection. LPA Villapudua-Soto and the Administrator conducted a joint inspection of the interior and exterior of the group home. The home is a three bedroom, two bath home. The home is licensed for a capacity of 3 ambulatory clients. The clients are developmentally disabled clients. Currently the group home has one client in care. The facility had the water heater repaired, LPA inspected the water heater and found that hot water in both showers are in good working condition. LPA Villapudua-Soto completed the remaining client/staff records and conducted interviews. LPA will return to deliver the citations at a later date due to technical computer difficulties.

met_with: Vanessa Baldwin, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday, October 1, 2024, at 10:15AM, Licensing Program Analysts (LPA) Brittany Crass and Alyssa Burgess made an unannounced annual inspection at the facility and met with the Administrator, Patricia Ambriz, who assisted with the inspection. LPA's and Administrator conducted a walk-through of the facility. LPA observed an office in the front entry, a dining area, kitchen, living room, three bedrooms, two bathrooms, a laundry room, two storage closets, and a backyard. The facility was in clean, safe, and sanitary condition, aside from the bedrooms which LPA observed sheets with particles and crumbs on them. The administrator stated the youth clean their rooms and make their beds after school, and that they are currently working towards making their beds before leaving for school. In the bedrooms LPA observed sufficient storage space, clean clothing, and desks for school work. Outside, LPA observed a trampoline with a portion of the outer, protective cushion missing, exposing the metal wire springs. The Administrator stated the youth do not use the trampoline anymore and during the visit, submitted a work order to have the trampoline removed by tomorrow. LPA observed chair cushions that had worn covers, exposing the inside cushion. LPA advised the administrator to replace them. In the kitchen, LPA observed at least the minimum requirement of two days of perishable foods. For non-perishable foods, LPA advised the administrator to purchase a few more non-perishable items such as canned soups, beans, rice, etc., as the 7 day requirement seemed low for the amount of youth in care. The hot water in the main bathroom measured at 112 degrees Fahrenheit maximum, which is within the required range of 105 - 120 degrees Fahrenheit. The carbon monoxide detector and smoke detector were operational. There were no buildings and ground deficiencies. (Continued on LIC 809-C). LPA observed that the Foster Youth personal rights, food menu, and complaint procedures were not posted at the facility, however the administrator printed and posted them during the visit. LPA reviewed that monthly board meetings are held every month however upon reviewing the minutes, LPA did not observe the topics needing to be discussed as stated in HSC 5021.1(f) being met. On this date, the facility is being cited for violations of the California Code of Regulations, Title 22, Division 6, Chapter 5, Section 84063(a)(9) on the attached D-Page. LPA also issued multiple Advisory Notes, which are not citations. LPA will return on another date to complete this inspection. An exit interview was conducted with the administrator, and a copy of this report and appeal rights were provided to them.

met_with: Patricia Ambriz


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On Wednesday, October 2, 2024, at 9:35AM, Licensing Program Analysts (LPA) Brittany Crass and Alyssa Burgess, made a subsequent unannounced annual inspection to the facility. LPA's met with Administrator, Patricia Ambriz, who assisted with the inspection. LPA's reviewed three children's files. LPAs found: two youths were missing their signature on their Admission Agreement, one Youth had the medication consent however it was not for Psychotropic Medication. One youth's Psychotropic Medications were not recorded on separate Psychotropic Medication Administration Records (PMAR) as required, and one child had the time missing on their PMAR. For the Needs and Services plans, 3/3 youth files did not list dietary needs, ability to manage their own money, visitation, and planned length of placement. Upon record review, LPA's observed that there was one adult who had a pending fingerprint clearance and was not cleared to work in the facility. The admin stated that effective immediately, this adult will not be at the facility until cleared. LPA's conducted two client interviews, and two staff interviews. Based on interviews, the Facility seemed knowledgeable on their roles, and no personal rights violations were indicated. LPA's recommend re-training on Mandated Reporter Training for all staff. On this date, the facility is being cited for violations of the California Code of Regulations, Title 22, Division 6, Chapter 1 and Chapter 5, Sections 84068(b) and 80019(e) on the attached D-Page. An immediate Civil Penalty in the amount of $500 is being assessed for Background Clearance violation. LPA also issued multiple Advisory Notes, which are not citations. (Report continued on LIC 809-C). LPA will return on another date to complete this inspection. An exit interview was conducted with Administrator and a copy of this report, confidential names list, and appeal rights were provided to her.

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility
84068.2(b): Needs and Services Plan

(b) The needs and services plan shall identify the child's needs in the following areas


summary: Facility Evaluation

raw_content:
Narrative:
On Friday, October 4th, 2024, at 10am, Licensing Program Analysts (LPA) Brittany Crass and Alyssa Burgess conducted a subsequent unannounced annual inspection at the facility. LPA's met with Administrator, Patricia Ambriz, who assisted with the inspection. LPA's reviewed three staff files, one Administrator file, and one Facility Manager file and found the following: current CPR certificates, Health Screening Reports, and 40 hour new hire training certificates. LPA confirmed the Facility Manager has received the Prudent Parent training. LPA reviewed yearly staff performance evaluations. LPA reviewed the facilities Disaster and Mass Casualty Plan. One advisory note is being given today, for HSC 1565, as items from Subsection 7 were missing from the plan, including provision of emergency power, and storage of medications. No deficiencies are being cited today. Exit interview conducted with the Administrator, report and appeal rights were given.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, Michelle Silvas, met with Joha Thomas, RBT, to deliver an Order to Licensee/Facility of an Immediate Exclusion from Facility letter. LPA was advised that the staff mentioned on the Immediate Exclusion, Joha Thomas is working at the facility but will leave the premises immediately. LPA hand delivered to Joha Thomas the Order to Licensee/facility of Immediate Exclusion from Facility. Notification is also being delivered to the other Adult Residential facilities # 487006085, # 486804106, # 486803543 that Joha Thomas is associated to. An exit interview was conducted, and a copy of this report was provided.

met_with: Joha Thomas, RBT


summary: Facility Evaluation

raw_content:
Narrative:
On 05/06/2021 at 4: PM, Licensing Program Analyst, Ignacia Villapudua-Soto conducted a case management inspection via facetime with Residential Administrator, Momo Duoa to discuss a home inspection that LPA conducted with House Manager. On 05/05/2021, LPA arrived at the facility and met with House Manager and jointly conducted a home inspection of the home inside and out and found the following deficiencies as follows: · X X 22 inflatable pool, full of water, (approximately, 2 feet of water) and flooding cover in the pool. LPA requested the water to be drained while LPA was present. (zero tolerance) · Air conditioner is not working. The temperature of the home was 90 degrees. · Outside patio, the air conditioner frame had old weathered wooden lattice that is broken and has protruding rusted nails sticking out · In the garage the sprinkler control system mounted to wall has exposed wires Clothing detergent, Air freshener and softener were accessible to clients Refer to D for Title 22 deficiencies cited. Exit interview was conducted and this document will be emailed to Residential Administrator for signature **Appeal rights given**

met_with: Momo Duoa, Residential Administration


facility_name: INCLUSION SPECIALIZED PROGRAMS LLC

raw_content:
Narrative:
Facility cited on the attached LIC 9099-D for violation of California Code of Regulations, Title 22, Division 6, regulation 80078(a) Responsibility for Providing Care and Supervision. Facility staff locked minor out of the facility and staff left minor unattended for an extended period of time. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On March 16, 2022 at 3:53pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC and spoke with Carla Flowers, House Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of two (2) clients, one of which is low-functioning non-verbal, eight (8) staff and one (1) witness was interviewed. Confidential interviews, documentary evidence, and LPA review of video footage of the incident revealed adequate supervision was not provided by staff, thus, Client #2 (C2) AWOL'd and Client #1 (C1) was left home alone and unsupervised for an extended period of time. Based on the interviews conducted, documentary evidence, and LPA video review, the preponderance of standard has been met, therefore the above allegation is found to be substantiated. Continued on LIC 9099-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 03/16/2022

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Carla Flowers-House Manager


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Additional statements made by W1 revealed that they do not believe the allegation is true and they do not have any concerns about S1 and C1's placement at the group home. Documentary evidence revealed Special Incident Report was submitted to Community Care Licensing (CCL) on 1/11/2023. LPA obtained a copy of the Special Incident Report and email documentation which reflects the date SIR submitted to CCL. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On March 7, 2023 at 3:21pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC met and spoke with Nnanyere Anyanwu, DSP. The purpose of this visit was to deliver the findings for the above complaint allegation. LPA was informed Ralph Munoz. Administrator was not at the facility. LPA spoke with Administrator by telephone and delivered the findings. During the investigation, a total of three (3) clients, four (4) staff and one (1) witness were interviewed. LPA conducted confidential interviews with clients and staff. Confidential interviews with Client #1 (C1) who is low-functioning non-verbal autistic did not reveal Staff #1 (S1) hit C1 with an object. Additional statements made by staff and Client #2 (C2) did not reveal that S1 hit C1 with a towel. Statements made by Witness #1 revealed that due to C1's autism, C1 will sometimes make up stories that are untrue. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 03/07/2023

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Nnanyere Anyanwu-DSP

complaint_status: unsubstantiated


raw_content:
Narrative:
Although, C1 engaged in self-injurious behavior which resulted in injury to C1, consistent statements revealed staff administered first aid for C1's injury. Consistent statements and documentary evidence also reveal paramedics were called to the facility to assess C1's injury. Although, paramedics assessed C1 and determined that C1 did not require transportation to a hospital emergency room at the time, it was suggested that C1 follow up with urgent care the following day. Confidential interviews revealed staff transported C1 to urgent care on 5/1/2023, the day after the incident. LPA obtained C1's urgent care discharge documentation, Westside Regional Center incident report, and a copy of the staff communication log. LPA was unable to corroborate the allegation, Staff are smoking marijuana on the premises. Confidential interviews and consistent statements did not reveal staff smoking marijuana on the premises of the facility. LPA obtained staffing weekly schedule. Based on the interviews conducted, documentary evidence and information gathered, LPA was unable to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. If any additional information is received, this complaint can be amended, and the finding can be changed. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On June 6, 2023, at 8:51am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC and spoke with Melissa Perez, House Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. LPA spoke with Ralph Munoz, Administrator by telephone and was informed Administrator is at another facility location. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegations. Based on interviews, documentary evidence, and statements obtained during the investigation process, LPA was unable to corroborate the allegation, Staff did not prevent minor from injuring himself. Confidential interviews revealed on 4/30/2023, staff attempted to calm Client #1 (C1) down by verbally re-directing C1 after C1 engaged in self-injurious behavior due to C1 being upset. Consistent statements revealed C1 began to hit their head against the wall. Documentary evidence revealed Client #1 (C1) engages in self-injurious behaviors. LPA obtained a copy of C1's Individual Program Plan (IPP). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 06/06/2023

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Melissa Perez - House Manager


raw_content:
Narrative:
Due to a lack of evidence obtained during the investigation, LPA determined that the allegation is Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left with the Facility Administrator

Investigation Findings:
13On January 12, 2023, at 11: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to INCLUSION SPECIALIZED PROGRAMS LLC to conclude the investigation.Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all available parties and gathered pertinent information in reference to the allegation. Confidential statements did not corroborate the allegation. The Licensee denied the allegation. Statements were consistent that Child #1 (C1) has been observed to be active, rolling on the floor, and falling to the ground. Statements indicate that facility staff conduct body checks every shift for all children in care. During investigation C1 was observed to have faint bruising to right arm/bicep area. Medical documentation received from the County of Los Angeles Medical HUB for a Forensic Evaluation dated 01/27/2023 indicates that there was no evidence of physical abuse and C1 is in a suitable placement. Statements indicated that staff observed bruising on C1 while bathing and immedialey reported to the facility administrator UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 01/12/2024

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Facility Administrator


raw_content:
Narrative:
Documentary and video evidence consistently indicated that C1 was observed at the birthday event in the street, being assaulted by multiple youth, and S2 and S3 did not intervene. Due to the evidence obtained during the investigation, LPA determined that the allegation is substantiated; means that that based on the preponderance of the evidence meaning that it is more likely than not, the allegations of Neglect/Lack of supervision is substantiated. The following deficiency is cited per California Code of Regulations, TITLE 22, DIVISION 6, Chapters 9.5. S2 and S3 did not provide supervision to C1 while at an offsite birthday party resulting in C1 being injured. A copy of this report and the Appeal Rights was provided to the licensee. An exit interview was conducted, and a copy of this report was left with the Assistant Program Director Blanca Macias. Due to a lack of evidence obtained during the investigation, LPA determined that the allegation is Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left with the Assistant Program Director Blanca Macias.

Investigation Findings:
13On January 31, 2024, at 9: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to INCLUSION SPECIALIZED PROGRAMS LLC to conclude the investigation. Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all available parties and gathered pertinent information in reference to the allegations. Statements and documentary evidence indicated that Staff #3 (S3) was scheduled to work on June 10, 2023, and assigned to transport and monitor Child #1 (C1) at an offsite birthday party. Statements indicated the while at the birthday party, C1 was outside unsupervised for an unknown length of time. Video evidence showed S2 and S3 not intervening as C1 engaged in a physical altercation which resulted in C1 sustaining injuries. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 01/31/2024

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Assistant Program Director Blanca Macias. Time Completed:12:15 PM Allegation(s): 1 2 3 4 5 6 7 8 91.Staff did not prevent minors from engaging in a physical altercation resulting in minor sustaining injuries. 2. Minor was left outside unattended for a long period of time. INVESTIGATION FINDINGS: 1 2 3 4 5 6 7 8 9 10 11 12 13On January 31, 2024, at 9:30 AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to INCLUSION SPECIALIZED PROGRAMS LLC to conclude the investigation. Prior to entering the facility LPA Gray conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all available parties and gathered pertinent information in reference to the allegations. Statements and documentary evidence indicated that Staff #3 (S3) was scheduled to work on June 10, 2023, and assigned to transport and monitor Child #1 (C1) at an offsite birthday party. Statements indicated the while at the birthday party, C1 was outside unsupervised for an unknown length of time. Video evidence showed S2 and S3 not intervening as C1 engaged in a physical altercation which resulted in C1 sustaining injuries. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024 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 5 Control Number 34-CR-20230616093908 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, 300 N. Continental Blvd. #290B EL SEGUNDO, CA 90245 FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: 198209622 VISIT DATE: 01/31/2024 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 26 27 28 29 30 31 32Documentary and video evidence consistently indicated that C1 was observed at the birthday event in the street, being assaulted by multiple youth, and S2 and S3 did not intervene. Due to the evidence obtained during the investigation, LPA determined that the allegation is substantiated; means that that based on the preponderance of the evidence meaning that it is more likely than not, the allegations of Neglect/Lack of supervision is substantiated. The following deficiency is cited per California Code of Regulations, TITLE 22, DIVISION 6, Chapters 9.5. S2 and S3 did not provide supervision to C1 while at an offsite birthday party resulting in C1 being injured. A copy of this report and the Appeal Rights was provided to the licensee. An exit interview was conducted, and a copy of this report was left with the Assistant Program Director Blanca Macias. SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024 LIC9099 (FAS) - (06/04)Page: 2 of 5 Control Number 34-CR-20230616093908 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, 300 N. Continental Blvd. #290B EL SEGUNDO, CA 90245 FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: 198209622 DEFICIENCY INFORMATION FOR THIS PAGE:VISIT DATE: 01/31/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 02/08/2024 Section Cited ILS 84478(b)1 2 3 4 5 6 7Responsibility for Providing Care and Supervision (b) As developmentally appropriate for the nonminor dependent, the licensee shall provide care and supervision as necessary to meet the needs of a nonminor dependent. 1 2 3 4 5 6 7The Deficiency was discussed with the Assistant Program Director. The Facility will submit a written plan of correction regarding policy and procedure to ensure all staff will provide proper care and supervision for all children in care and to ensure that new and experienced staff 8 9 10 11 12 13 14This requirement is not met as evidenced by: Staff #2 and Staff #3 did not provide the proper care and supervision for C1 while on an offsite birthday party. 8 9 10 11 12 13 14receive refresher training that meet the needs of the children. The facility conducted an internal investigation, implemented disciplinary action against the staff involved in the incident and required that all staff be trained. Verification of training is due February 8, 2024. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024 LIC9099 (FAS) - (06/04)Page: 5 of 5 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, 300 N. Continental Blvd. #290B EL SEGUNDO, CA 90245 This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/16/2023 and conducted by Evaluator Rosslyn Y. Gray COMPLAINT CONTROL NUMBER: 34-CR-20230616093908 FACILITY NAME:INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER:198209622 ADMINISTRATOR:OKECHUKWU NDUKUBAFACILITY TYPE: 730 ADDRESS:5130 W. 137TH PLACETELEPHONE: (310) 644-4259 CITY:HAWTHORNESTATE: CAZIP CODE:90250 CAPACITY:3CENSUS: 3DATE: 01/31/2024 UNANNOUNCED


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed staff at the facility and upper management. LPA Jones-Steward also interviewed C1 and the co-complainant. The original complainant did not return requests for additional information. LPA also reviewed investigations by the Regional Center and the facility as well as photographs of the bruises on C1. The allegations were resolved as unsubstantiated for the following reasons: C1 was vague and contradictory about how he obtained the bruises on his shoulders. The photographs do not support the allegation that the bruises were caused by someone grabbing him by the shoulders. Staff #2 and Staff #3 denied that the allegations occured. Staff #1 cannot be reached due to extended leave, Other sources indicate that C1 has a history of making false allegations against his caregivers. An unsubstantiated finding means that although an allegation may have occurred, there is not a preponderance of evidence that it did occur. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 08/20/2024 and conducted by Evaluator Connie Jones-Steward COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: ADMINISTRATOR:CECILIA PANTALEONFACILITY TYPE: ADDRESS: W. 137TH PLACETELEPHONE: (310) 644- CITY:HAWTHORNESTATE: CAZIP CODE: CAPACITY:3CENSUS: 3DATE: 09/23/ UNANNOUNCEDTIME BEGAN: 09: AM MET WITH:Chima Uka, Registered Behavior TherapistTIME COMPLETED:10: AM 9Reporting Requirements -Facility did not report bruises that were found on client INVESTIGATION FINDINGS: 13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA reviewed the Special Incident Report file on the Department's database and found no mention of this incident. Based on the foregoing, this allegation was resolved as substantiated. A substantiated finding means that there is a preponderance of evidence that the allegation occurred. The facility was cited under Title 22 80061(b)(1)(E). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: 198209622

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:


summary: Facility Evaluation

raw_content:
Narrative:
On January 20, 2022 at 10:58am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC, for the purpose of conducting an annual required inspection at the above location. LPA met with Raymundo Lopez, Assistant Administrator who granted access to the facility for inspection. The facility is licensed to provide care and supervision for three (3) male and female children, ages 6-17 years old. Three (3) children may be non-ambulatory. The census on the date of this visit is two (2). There is no swimming pool or bodies of water on the premises. The facility has a living room, dining room, family room/staff office, laundry room, three (3) bedrooms, two (2) bathrooms, backyard with detached garage. Living Room: Sofa, love seat and entertainment area (TV, computers, etc.) for residents. All furnishings in good repair. Dining Room: Table with four (4) chairs in good repair for resident dining. Kitchen: Equipped with refrigerator, 4 burner gas stove, oven, and microwave. There is adequate perishable and nonperishable food supply. Facility provides nutritious snacks between meals. Laundry Room: Equipped with a washer and dryer. Locked cabinet space stores laundry products and personal hygiene products. Continued on LIC 809-C Family room/Staff Office: Equipped with a sofa, TV, desk, locked cabinets for staff/client records. Closet space for extra linens and towels. Bedroom #1: Occupied by one (1) client. Has one (1) full bed in the room. Room is well furnished and has adequate closet space for storage. Bedroom #2: Vacant. Has one (1) full bed in the room. Room is well furnished and has adequate closet space for storage. Bedroom #3: Occupied by one (1) client. Has one (1) full bed in the room. Room is well furnished and has adequate closet space for storage. Bathroom #1: Clean and operable at the time of the visit. Hot water kept at a safe temperature. Bathroom #2: Clean and operable at the time of the visit. Hot water kept at a safe temperature. Backyard: Has no debris or hazardous materials. Detached garage used for storage. During this visit, LPA reviewed two (2) client Records which contained copies of Needs and Service Plans and Medical Authorizations signed by each child and their authorized representative. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported by Facility Manager that children attend school, extracurricular, cultural and personal enrichment activities. LPA will conduct client interviews at a later date. Continued on LIC 809-C The home was inspected, and the following was observed: The home is clean, safe, and sanitary. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Hot water kept at a safe temperature. The beds have comfortable mattresses, clean linens, blankets and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. First aid kit was checked and found to have appropriate supplies. All fire extinguishers are fully charged. All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone accessible to clients for use at all times. Facility vehicle is currently registered and has valid liability insurance and is in good repair. Children's Personal Rights and house rules are posted. Outdoor activity space is free of obstruction and debris. LPA will review staff records and conduct staff interviews at a later date. LPA requested CARF accreditation and Board of Director's meeting minutes from the last meeting. LPA reviewed training log for all staff at the facility. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. LPA informed Assistant Administrator of licensing fees of $454.00 due by 03/26/2022. No deficiencies were cited. An exit Interview was conducted, and a copy of this report will be emailed to the Assistant Administrator.

met_with: Raymundo Lopez-Assistant Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 24, 2022 at 1:37pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC, for the purpose of conducting a case management for an annual required inspection which took place on January 20, 2022 at the above location. LPA met with Raymundo Lopez, Assistant Administrator who granted access to the facility for inspection. The facility is licensed to provide care and supervision for three (3) male and female children, ages 6-17 years old. Three (3) children may be non-ambulatory. The census on the date of this visit is two (2). There is no swimming pool or bodies of water on the premises. The facility has a living room, dining room, family room/staff office, laundry room, three (3) bedrooms, two (2) bathrooms, backyard with detached garage. During this visit, LPA attempted to conduct one (1) client interview. Client is low-functioning non-verbal and was unable to answer all interview questions. Additional client interview will be conducted on a later date. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural and personal enrichment activities. LPA reviewed six (6) staff records and conducted three (3) staff interviews. LPA requested and received Board of Director's minutes from the last meeting. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. Continued on LIC 809-C The home was inspected, and the following was observed: The home is clean, safe, and sanitary. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Hot water kept at a safe temperature. The beds have comfortable mattresses, clean linens, blankets, and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. First aid kit was checked and found to have appropriate supplies. All fire extinguishers are fully charged. All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone accessible to clients for use at all times. Children's Personal Rights and house rules are posted. Outdoor activity space is free of obstruction and debris. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit Interview was conducted, and a copy of this report will be emailed to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On July 20, 2023 at 2:55pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Inclusion Specialized Programs LLC and spoke with Carlos Peoples, Residential Behavior Technician. The purpose of this visit is a Case Management for Complaint Investigation 34-CR-20230501145238. LPA was informed Cecilia Pantaleon, Administrator is not at the facility. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegation. Based on interviews, documentary evidence, and statements obtained during the investigation process. Although, LPA was unable to corroborate the allegation, Staff did not prevent minor from injuring himself. Confidential interviews revealed inconsistent statements regarding when staff should call emergency personnel when clients are experiencing a medical emergency. Minor was banging their head against a wall and sustained an injury as a result of the self-injurious behavior. LPA issued a technical assistance and advised that additional staff training be conducted on medical emergency procedures for clients and to submit staff training documentation to LPA by August 21, 2023. Residential Behavior Technician stated will inform Administrator of the technical assistance advisory. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

met_with: Carlos Peoples-Residential Behavior Technician


summary: Facility Evaluation

raw_content:
Narrative:
On March 21, 2024 at 9:45 am, Licensing Program Analyst (LPA) Deborah Lee made an unannounced visit to Inclusion Specialized Programs LLC, for the purpose of conducting an annual required inspection at the above location. LPA met with Queen Omeje, Assistant Administrator who granted access to the facility for inspection. The facility is licensed to provide care and supervision for three (3) male and female children, ages 6-17 years old. Three (3) children may be non-ambulatory. The census on the date of this visit is 3. There is no swimming pool or bodies of water on the premises. The facility has a living room, dining room, family room/staff office, laundry room, three (3) bedrooms, two (2) bathrooms, backyard with detached garage. Living Room: Sofa sectional and entertainment area with mounted TV and end tables. The entry way contains a table with sign-in sheets, anti-bacteria wipes, tissues and masks in addition to a thermometer. All furnishings in good repair. Dining Room: Equipped with a six (6) chair dinning table which is in good repair and adequate for resident dining. Kitchen: Equipped with refrigerator/freezer, 4 burner gas stove, oven, and microwave. There is adequate perishable and nonperishable food supply. Facility provides nutritious snacks between meals. Laundry Room: Equipped with a washer and dryer. Locked cabinet space stores laundry products and personal hygiene products. The home was inspected, and the following was observed: The home is clean, safe, and sanitary. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Hot water kept at a safe temperature. The beds have comfortable mattresses, clean linens, blankets and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. Page 1 of First aid kit was checked and found to have appropriate supplies. All (2) fire extinguishers are fully charged. All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone accessible to clients for use at all times. Facility vehicle is currently registered and has valid liability insurance and is in good repair. Children's Personal Rights and house rules are posted. Outdoor activity space is free of obstruction and debris. LPA reviewed ( 4) staff files. Per review of files, ( 4 )out of ( 4 ) files met current licensing requirements. LPA reviewed (3 ) client files. Per review of files, ( 3 ) out of ( 3 ) files met current licensing requirements. LPA conducted ( 2 ) staff interviews. Clients are Regional Center consumers and are non-verbal; unable to answer questions. LPA reviewed the training log for all staff at the facility. Caregiver(s)/adults working in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. Fire Drill log also reviewed during this inspection The home is operating within the capacity and limitations of the license. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit Interview was conducted, and a copy of this report will be emailed to Administrator Cecilia Pantaleon. Page 2 of 2

met_with: Queen Omeje, Assistant Administrator


raw_content:
Narrative:
LPA Sanchez P. also conducted a confidential interview with a collateral contact who reported not having any concerns regarding abuse or neglect being done to C1 by facility staff. Lastly, confidential interviews conducted further revealed that there is no evidence to determine that staff did not prevent C1 from engaging in inappropriate sexual behaviors. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview was completed and copy of the report and appeal rights were discussed and provided to Queen Omeje, Administrator .

Investigation Findings:
13On October 17, 2025, at 10:10am Licensing Program Analyst (LPA), Emelyn Sanchez P. made an unannounced visit to the above facility to conclude the complaint investigation and to deliver the findings on the above allegations. LPA Sanchez P. met with Queen Omeje, Administrator . During the investigation, LPA Sanchez P. conducted interviews with all available parties and gathered pertinent information in reference to the complaint allegations. LPA Sanchez P. reviewed the LIC 500- Personnel Report, Individual Program Plan (IPP) Progress Reports, Client Development Evaluation Report, Body Check Forms and a Special Incident Report dated 08/03/2024 for C1. Based on the confidential interviews conducted with staff regarding the allegation of staff causing an injury to C1 it was reported that C1 had major behavioral issues and had a tendency of making accusations against staff. Report Cont. on LIC 9099-C. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Emelyn Sanchez Peralta LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLCFACILITY NUMBER: VISIT DATE: 10/17/2025

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Queen Omeje, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 10, 2026 at 8:45 am, Licensing Program Analyst (LPA) Lanice White made an unannounced visit to Inclusion Specialized Programs LLC, for the purpose of conducting an annual required inspection. LPA met with Vanessa Vazquez, Assistant Administrator who granted access to the facility for inspection. The facility is licensed to provide care and supervision for three (3) male and female children, ages 6-17 years old. Three (3) children may be non-ambulatory. There are no swimming pool or bodies of water on the premises. Living Room: Sofa sectional, Bing bang chair, entertainment area with mounted TV and (2) end tables. The entry way contains a table with sign-in sheets, tissues and masks. All furnishings in good repair. Dining Room: Equipped dining table with (3) chairs which is in good repair and adequate for resident dining. Kitchen: Equipped with refrigerator/freezer, 4 burner gas stove, oven, and microwave. There is adequate perishable and nonperishable food supply. Facility provides nutritious snacks between meals. Laundry Room: Equipped with a washer and dryer. Locked cabinet space stores laundry products and personal hygiene products. Bedroom #1: Occupied by one (1) client. Has one (1) full bed in the room. Room is well furnished and has adequate closet space for storage (Continued see 809-C page 2) Page Bedroom #2: Occupied by one (1) client. Has one (1) full bed in the room. Room is well furnished and has adequate closet space for storage. Bedroom #3: Occupied by one (1) client. Has one (1) full bed in the room. Room is well furnished and has adequate closet space for storage. Bathroom #1: Clean and operable at the time of the visit. Hot water kept at a safe temperature. Bathroom #2: Clean and operable at the time of the visit. Hot water kept at a safe temperature. The home was inspected, and the following was observed: The home is clean, safe, and sanitary. Sharp knives, disinfectants/cleaning solutions, and medicines are made inaccessible to the children. Hot water kept at a safe temperature of 105 degrees. The beds have comfortable mattresses, clean linens, blankets and pillows, all in good repair. Caregiver maintains a safe and comfortable temperature in the home. First aid kit was checked and found to have appropriate supplies. All (1) fire extinguishers are fully charged. All smoke detectors and carbon monoxide detectors tested audible and were working properly. Emergency numbers, facility license, evacuation plan, and first aid information were posted. No guns or weapons are in the home. There is a working telephone accessible to clients for use at all times. Facility vehicle is currently registered until 1/2/2027 and has valid liability insurance until 8/28/2026 and is in good repair. Children's Personal Rights and house rules are posted. Outdoor activity space is free of obstruction and debris. LPA reviewed the training log for all staff at the facility. Caregiver(s)/adults working in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. Fire Drill log also reviewed during this inspection The home is operating within the capacity and limitations of the license. (Continued see 809-C page 3) Page LPA reviewed ( 3 ) staff files. files met current licensing requirements. LPA reviewed (3 ) client files. files met current licensing requirements. LPA conducted ( 2 ) staff interviews. Clients are Regional Center consumers and are non-verbal; unable to answer questions. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit Interview was conducted, and a copy of this report left with Assistant Administrator Vanessa Vazquez.


facility_name: INCLUSION SPECIALIZED PROGRAMS LLC-HUNTINGTON

summary: Facility Evaluation

raw_content:
Narrative:
On February 10, 2022 at 9:30am, Licensing Program Analyst (LPA) Gilbert Gutierrez, conducted an annual/required inspection at the facility and met Cecilia Pantaleon, Residential Director/Administrator. The facility is a one story home with 4 (four) bedrooms and 3 (three) bathrooms and detached garage. Currently there are 2 clients placed in the facility. At the time of LPA's arrival, no clients present in the facility. Physical Plant LPA started the inspection at about 9:45am. LPA together with a staff toured the facility inside and out. The inspection ended at 10:30am. LPA observed the following: the posted license, emergency disaster plan, personnel schedule, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has a single bed with clean sheets and linens. There are adequate drawers and closet space for the client's clothing. There are extra linens, adequate towels and hygiene supplies in the facility. Only one client sleeps in a room. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. All medications are stored locked in a metal cabinet inside a room. There is a working telephone for clients use. The first aid kit was complete and readily available. The water temperature is 113 degrees within the temperature allowed by Title Regulations. The smoke/carbon monoxide detectors are working. All passageways are unobstructed. LPA started the interview at 11:30pm. LPA interviewed two (2) clients and three (3) staff members. Client Records At around 1:00pm, LPA reviewed 2 (two) client records and finished at 2:00pm. All client records are available to licensing agency to inspect, audit upon demand. Client records contain required information including, but not limited to, consent forms, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, education records, personal rights forms, and medication administration records. Staff Records At 2:15pm, LPA reviewed 8 (eight) staff records and finished at 4:50pm. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator and facility managers meet the required qualification and/or experience. An exit interview was conducted and no citation issued at this time. A copy of this report and LIC 811 were provided to the administrator.. This is an amended report of the original provided to the facility on 02/10/22

met_with: Cecilia Pantaleon


summary: Facility Evaluation

raw_content:
Narrative:
On April 12, 2022 at 2:00pm, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a case management inspection at the facility and met Administrator Guadalupe Galindo. Licensee notified the Department about the decision to close the facility effective 4/16/22. LPA conducted the inspection with the administrator at 2:05pm. During the inspection, no clients present in the facility premises and no personal belongings of the clients observed in the facility. Administrator Galindo surrendered the facility license to this LPA. An exit interview was conducted, and a copy of this report was provided to the administrator.

met_with: Guadalupe Galindo


facility_name: INCLUSION SPECIALIZED PROGRAMS LLC - DAWN

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted an unannounced case management inspection on 3/7/2022 related to an incident report dated 2/25/2022. LPA reviewed the incident report with the Administrator. The Administrator provided detailed information, including documentation regarding the client's behaviors and contact information for the Service Coordinator at Regional Center of the East Bay. No citations were issued and a copy of the report was provided to the Administrator.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 4/6/2022 with the Facility Administrator. Community Care Licensing file, incident reports, facility roster, facility profile and complaint history were reviewed prior to visit at the facility. The licensing fees are current. The Facility has a capacity of 4 and currently has 3 residents. There are 10 staff members associated to the license and 3 currently working at the Facility. LPA reviewed 5 staff files, all which were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 3 client files were reviewed. The client's Individual Program Plan, Behavioral Plan (IBST) and reviews were complete and up to date. Immunization records were current. Medical consent forms were signed by authorized representative and current. Additionally, the client's file had a record of personal property. Personal rights, menu, license and emergency exit plan were posted. The facility was inspected jointly with the Facility Administrator. Client interviews were not possible due to their diagnosis of intellectual disability and/or Autism, the clients are not able to communicate verbally or have limited communication skills. There are 4 bedrooms and 2 bathrooms. Each client has their own bedroom. Each bedroom had a firm mattress, with a bed cover, sheets, blanket and pillows. The common area has couches and chairs to sit in, and a TV. The facility is in good repair. There are locked cabinets in the laundry room with cleansers and detergents. Additional linen if needed for the bedrooms and the bathrooms are kept in a hall closet. Client and staff files are in locked cabinets in the office area. The passageways from the front to the back of the facility are unobstructed. LPA observed in the backyard and saw a patio table with chairs and a scooters for the clients. LPA observed enough perishable/non-perishable food for 3 client for 4 days/2 weeks. Smoke detectors are in working order. There is a carbon monoxide monitor and 1 fully charged fire extinguisher. Sharps were kept locked in the kitchen. The kitchen was stocked with plates, utensils and drinking cups sufficient for 4 clients. The water temperature from the kitchen faucet was 109.5 degrees. The clients' hygiene kits were stocked and stored in the second bathroom. A fully stocked first aid kit is kept in the kitchen. An exit interview was conducted and discussed with the Facility Administrator. One citation was issued on a D page and a copy of the annual inspection report and appeal process was provided.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted a case management inspection on 4/24/23 with the facility administrator related to the incident report dated 4/21/23. C1 came home from school very upset and escalated. C1 had possession of some items that posed a potential threat to C1 and others in the facility. LPA requested clarification regarding the items found in C1's bedroom when C1 returned from school. After obtaining clarification, LPA requested the administrator reach out to the school to address items C1 states C1 obtained from school and how to prevent future issues resulting in C1 bringing home inappropriate items from the school. No citations were issued. An exit interview was conducted and a copy of this report was provided to the facility.


raw_content:
Narrative:
The facility staff denied the allegations indicated when clients are attempting to harm each other staff will attempt to intervene, redirect and separate clients. The facility staff indicated staff called law enforcement during the incident. The confidential interviews conducted did not collaborate the allegation. LPA interviewed two clients who indicted staff intervened during the fight between the clients. The clients stated staff separated the clients and called law enforcement. The two clients stated feeling safe living at the facility and did not have any issues with the facility. LPA attempted to interview another client however the client is nonverbal. The RCC indicated having no concerns with the facility. Based on the interview and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On October 20, 2022 at 10: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the Facility Administrator Guadalupe Gallindo. During the course of the investigation, LPA Cabral interviewed three facility staff and one client on 7/13/22. LPA attempted to interview one client on 10/14/22 and interviewed another client on 10/17/22 (see Confidential Names Form LIC 811 dated October 20, 2022). LPA Cabral interviewed one regional center coordinator (RCC) on 10/17/22 and attempted to interview two RCCs on 7/14/22. LPA reviewed incident reports and the other agencies investigative narrative on 10/17/ On 7/6/22 the department received a complaint alleging client is causing harm to other clients while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLC - MARISMAFACILITY NUMBER: VISIT DATE: 10/20/2022

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Guadalupe Gallindo, Administrator


raw_content:
Narrative:
With regards to the allegations of a client having access to marijuana and the facility providing inadequate supervision to a client, there was insufficient evidence to corroborate the allegations. Facility staff denied providing the client with any contraband or neglecting the client resulting in the client obtaining and consuming marijuana. The facility client was unable to provide a meaningful statement as the client was autistic and non-verbal. Facility incident reports indicated that even when the client left the facility without approval, staff were with the client to re-direct the client back to the facility as it would have been a safety risk for the client if the client were left alone at any point in time. With regards to the allegation of improper restraint, there was insufficient evidence to corroborate the allegation. The investigation revealed that the facility client had a history of risk behavior and tendency to either self-harm or harm others in the facility or during outings. Facility staff statements and incident reports reflected that staff acted appropriately during such incidents of risk behaviors with the client. With regards to the allegation of the facility mishandling the client's medication, there was insufficient evidence to corroborate the allegation. The investigation revealed that the facility client was put on a 5150 hold after law enforcement was summoned at an incident where the client became non-compliant and exhibited risk behaviors while he was in the facility vehicle attempting to elope and destroy property. Once the client was at the hospital, a medication change occurred. Once the client returned to the facility and back to school, the facility provided administered the client's medication in a timely manner. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met although the allegations may have happened or are valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On August 18, 2023 at 1: PM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. LPA Rarela discussed the findings with the facility representative named above. During the course of the investigation, LPA interviewed the facility personnel on 2/9/23, 2/22/23 and 8/18/23, the complainant on 2/9/23, school personnel on 2/9/23; the two facility clients at the time of the start of the investigation were non-verbal (see Confidential Names Form dated August 18, 2023). LPA also obtained and reviewed medical records, incident reports, the client's Individual Program Plan and personnel files. The following allegations were made: Facility client had access to marijuana, Facility did not provide adequate supervision to a client, Facility client was improperly restrained, and Facility mishandled the client's medication. (CONTINUED) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: INCLUSION SPECIALIZED PROGRAMS LLC - MARISMAFACILITY NUMBER: VISIT DATE: 08/18/2023

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Domingo Alonzo, Facility Manager


facility_name: INCLUSION SPECIALIZED PROGRAMS LLC - MARISMA

summary: Facility Evaluation

raw_content:
Narrative:
On July 22, 2021 at 10:19AM, Licensing Program Analyst (LPA) Gilbert Gutierrez went to the facility and met Facility Manager, Georgina Doyle. The purpose of the visit was to provide a copy of the Proposed Decision and Decision and Order dismissing the accusation against Staff Reference #1 (S1) see (LIC 811) Confidential Names List to licensee. An exit interview was conducted, and a copy of the Order and this report were provided to the facility representative. No deficiency citations issued.

met_with: Georgina Doyle


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Gilbert Gutierrez and Pamela Silva on February 25, 2022 at 9:00am. During the inspection, LPAs met Guadalupe Galindo, Administrator who provided the tour of the facility inside and out at 9:25am.. At the time of the inspection, there were three (3) staff in the facility. LPAs interviewed a total of two (2) staff at 9:40 am. LPAs reviewed a total of three (3) staff records at 10:00am. No client currently placed in the facility is a dependent of the court. No client files reviewed and no client interviews conducted. No deficiency citations issued at this time. An exit interview was conducted and copy ot this report and LIC 811 were provided to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On April 11, 2022 at 9:15am, Licensing Program Analyst (LPA) Gilbert Gutierrez, conducted an annual/required inspection at the facility and met Facility Manager (FM) John Hansen. Residential Director Cecilia Pantaleon and Guadalupe Galindo, Administrator arrived shortly. The facility is a one-story home with four bedrooms and three bathrooms and attached garage. Currently there are three clients placed in the facility. At the time of LPA's arrival, two of the clients were present. The Residential Director provided the roster of clients, Personnel Report, Emergency Disaster Plan, Property and Incidental (P&I), Centrally Stored Medication and Destruction Logs, Emergency Intervention log and Board Meeting Minutes. Physical Plant LPA started the inspection at about 9:30am. LPA together with FM toured the facility inside and out. LPA observed the following: the posted license, emergency disaster plan, personnel schedule, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are locked and inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has a single bed in good repair with clean sheets and linens three drawers and closet space for the client's clothing. There are extra linens, adequate towels and hygiene supplies. Only one client sleeps in a room. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. There are lights in the rooms and throughout the facility. The faucets for client's use deliver hot water (116 degrees Fahrenheit) within the temperature allowed under Title Regulations. The fireplace has cover for client's safety. All medications are stored locked in a metal cabinet. There is a working telephone for clients to use. The first aid kit was complete and readily available. There are working smoke/carbon monoxide detectors in the facility. The delayed egress doors are working. All indoor and outdoor passageways are unobstructed. LPA interviewed two clients at 10:15am. One of the clients was non-verbal and not interviewed. Client Records At around 11:00am, LPA reviewed three client records. All client records are available to LPA to inspect, audit upon demand. Client records contain required information including, but not limited to, consent forms, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, education records, personal rights forms, and medication administration records. : LPA started the interview of four staff at 12:10pm. Staff Records At 2:00pm, LPA reviewed six staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. However, licensee needs to fix the dates the training was completed by the staff. The administrator and facility managers meet the required qualification and/or experience. No deficiency citation issued at the time of the inspection. A copy of the LIC 809, LIC 809C LIC 858, LIC 859, and LIC 9102 were provided to the administrator.

met_with: Cecilia Pantaleon.Guadalupe Galindo & John Hansen


summary: Facility Evaluation

raw_content:
Narrative:
On February 2, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez, conducted an annual/required inspection at the facility and met Administrator Guadalupe Galindo. Residential Director Cecilia Pantaleon arrived shortly. The facility is a one-story home with four bedrooms and three bathrooms and attached garage. Currently there are three clients placed in the facility. At the time of LPA's arrival, one of the clients was in the facility but not interviewed. The Administrator provided the roster of clients, Personnel Report, Emergency Disaster Plan, Property and Incidental (P&I), Centrally Stored Medication and Destruction Logs, Emergency Intervention log and Board Meeting Minutes. Physical Plant LPA started the inspection at about 9:30am. LPA together with Ms. Pantaleon toured the facility inside and out. LPA observed the following: the posted license, emergency disaster plan, personnel schedule, client personal rights, and grievance procedure. The disinfectants, cleaning solutions, sharp objects are locked and inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has a single bed in good repair with clean sheets and linens three drawers and closet space for the client's clothing. There are extra linens, adequate towels and hygiene supplies. Only one client sleeps in a room. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. There are lights in the rooms and throughout the facility. The fireplace has over for client's safety. All medications are stored locked in a metal cabinet. There is a working telephone in the facility. The first aid kit was complete and readily available. The smoke/carbon monoxide detectors and delayed egress doors are working. All in sink was 122 degrees however, licensee was able to lower the temperature to 115 degrees before LPA left the facility. Client Records At around 10: AM, LPA reviewed three client records. All client records are available to LPA to inspect, audit upon demand. Client records contain required information including, but not limited to, consent forms, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, personal rights forms, and medication administration records. All clients placed in the facility currently are non-verbal. Staff Records At 12: PM, LPA reviewed six staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator and facility managers meet the required qualification and/or experience. LPA interviewed 2 staff in the facility. A deficiency citation is issued at the time of the inspection. A copy of the LIC 809, LIC 809C LIC 809D, LIC 811s, and LIC 9102 were provided to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Dina Camara conducted a case management inspection 03/15/23 at 11: AM based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 2 out of 2 youth files were reviewed. 2 out of Direct Care Staff and 0 out of 2 youth were interviewed. Youth are non-verbal. (See the Confidential Names List, LIC 811, dated 03/15/23). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments and youth case plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Dina Camara did not observe documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Crisis Management Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Guadalupe Galindo, Administrator.

met_with: Guadalupe Galindo, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Timika Martin and Pamela Silva on November 1, 2023, at 10:00AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Martin and Silva met with Administrator, Guadalupe Galindo and inspected the facility inside and out. All clients at this facility are Regional Center placement's. Therefore, no files were inspected, and no interviews were conducted with clients. LPAs reviewed 0 of child's records and 3 of staff personnel files on site at the facility. LPAs reviewed 0 of child's psychotropic medications and medication records. LPAs interviewed 3 of the staff on site to discuss the facilities policies and procedures of operation. LPAs interviewed 0 of children currently prescribed psychotropic medication. LPAs provided a copy of this licensing report to Administrator, Guadalupe Galindo. No deficiencies are being cited at this time. LPAs conducted exit interview with Administrator, Guadalupe Galindo.