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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191804850
Report Date: 04/14/2022
Date Signed: 04/14/2022 04:44:50 PM


Document Has Been Signed on 04/14/2022 04:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: DATE:
04/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Mary Nouskajian, DirectorTIME COMPLETED:
04:45 PM
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On 04/14/2022 1:20PM, Licensing Program Analyst (LPA) Denise Miranda arrived at Fountain Nursery School, located at 1128 N. Orange Grove Ave, Los Angeles, CA 90046 for the purpose of following up on the self reported unusual incident that occurred at the facility on 03/11/2022, the correct day the incident was on 3/10/2022. The LIC 624 Unusual Incident /Injury Report (UIR) was received on 03/28/2022. Upon arrival at the facility, LPA met with Mari Nouskajian, Licensee/Administrator and Tori Hatch, Director Assistant and discussed the purpose of the visit.

According to the report that the Department received, on 03/10/2022 child#1 was disrupting table activities
Teacher#1 and #2 attempted to discuss with child#1 and attempted to redirect child multiple times. Teachers moved
child#1 to another table facing to the wall during activity time and let the child#1 have the activities on an individual
table. Per report, parents of the child#1 raised concerns with the personal right of their child.
During this inspection, LPA conducted interviews with facility individuals that were involved in the incident.
LPA obtained a copy of the sign in and sign out sheet dated 03/10/2022, LIC9040 Children’s Roster, LIC500 Personnel Record, and pertinent documents. Files teacher’s and child files were reviewed.

At this time, further investigation is needed. An exit interview was conducted and a copy of this report along with the Notice of Site Visit were provided to Mari Nouskajian, Licensee/Administrator.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022
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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