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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191804850
Report Date: 05/19/2022
Date Signed: 05/19/2022 04:29:45 PM


Document Has Been Signed on 05/19/2022 04:29 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: 90DATE:
05/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Mary Nouskajian, Owner and Mr. Andrew Rakos, CFOTIME COMPLETED:
04:35 PM
NARRATIVE
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On 05/19/2022 3:10PM, 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 Andrew Rakos, CFO 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.

Based on the information obtained and interviews conducted, the preponderance of evidence standard has been met, it appears that the incident occurred on 3/10/2022 was the result of a Title 22 violation for personal of rights of the child in care. Although Staff #1 and #2 stated that child was placed on separated table facing to the wall was not intentional, however, facility and staff fail to communicate between
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: FOUNTAIN NURSERY SCHOOL, INC.
FACILITY NUMBER: 191804850
VISIT DATE: 05/19/2022
NARRATIVE
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them and parents regarding this child’s needs.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D)

An exit interview was conducted and a copy of this report, appeal rights and Notice of Site Visit was provided to Mary Nouskajian, Licensee/Administrador.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/19/2022 04:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2022
Section Cited

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Personal Rights: (a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her
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personal relationships with staff and other persons.
Based on the information obtained and interviews conducted, the preponderance of evidence standard has been met, it is revealed that the incident occurred on 3/10/2022 violated to the child’s personal rights. Facility and Staff fail to communicate between them and parents regarding child’s needs which poses/posed a potential health, safety or personal rights risk to child care.
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care. Provide plan when teacher observe behavior issues with a child in care. Also, Owner will conduct a training with Teachers and Staff regarding Personal Rights and Policy of Child’s Discipline. A copy of the plan when Teacher observe behavior issues with child in care, agenda and attendance sign by all staff will be provide via email to LPA Miranda no later than 6/3/2022. Per Owner, employees handbook was revised and was provided to all teacher and staff on 4/20/22.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2022
LIC809 (FAS) - (06/04)
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