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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191804850
Report Date: 06/25/2019
Date Signed: 06/25/2019 02:35:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:FOUNTAIN NURSERY SCHOOL, INC.FACILITY NUMBER:
191804850
ADMINISTRATOR:MARY NOUSKAJIANFACILITY TYPE:
850
ADDRESS:1128 N. ORANGE GROVE AVE.TELEPHONE:
(323) 654-8958
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:145CENSUS: 117DATE:
06/25/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Mary Nouskajian - Director TIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA), Peter Flores conducted a Case Management inspection for the purpose of an Immediate Action Required.

RO Received CBCB notice of IMMEDIATE ACTION REQUIRED Criminal Record Exemption Needed for ELHAMARNEH, JENNIFER.

ELHAMARNEH, JENNIFER, applied for employment but was never hired.

ELHAMARNEH, JENNIFER, cannot work, be present in your facility unless a criminal record exemption is granted. Pursuant to state law, an exemption may be granted if the CBCB is in receipt of substantial and convincing evidence that the individual is of present good character.

Director Replied to the CBCB Letter

Director Mary Nouskajian signed the ACTION REQUEST notice stating "I will not employ this individual or allow him/her to reside in my facility. Please disassociate this individual from my facility.

LPA obtained a copy of the ACTION REQUEST notice signed and dated by Director Mary Nouskajian.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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