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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191804850
Report Date: 06/23/2022
Date Signed: 06/23/2022 12:14:26 PM


Document Has Been Signed on 06/23/2022 12:14 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: 110DATE:
06/23/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Tori Hatch, Director Assistant, Andrew Rakos, CFOTIME COMPLETED:
12:20 PM
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On 06/23/2022 at 10:03AM, Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced Case Management – COVID-19 inspection for the purpose of following up on 3 Unusual Incident Reports (UIR) submitted on 06/8/2022, 06/10/2022 and 06/15/2022. Also, present was Joseph Tran, Registered Nurse, from Los Angeles County Health Department – Outbreak Management Branch.

LPA Miranda met with the Tori Hatch, Director Assistant, who toured LPA Miranda and Mr. Tran through the inside and outside of the facility. There are 110 children in care with 31 staff and Director. LPA observed all children are under supervision, including visual supervision, of teachers at all times.

  • According to the UIR, on 06/7/2022 – 4 cases were reported as testing positive for COVID-19.
  • According to the UIR, on 06/10/2022 – 1 case was reported as testing positive for COVID-19.
  • According to the UIR, 06/15/2022 – 13 cases were reported as testing positive for COVID-19.
Per Director assistant, all staff and children were reported with positive COVID-19 to be present during visit and no additional positive COVID-19 has been reported since 06/15/2022.

LPA observed children’s from the exposed classroom using masks and additional mask in cubbies, staff wearing masks, soap and paper towels were observed to be available at all handwashing sinks and hand sanitizer available in each room. LPA observed children’s playing at the outdoor space with optional wearing mask. Facility has zono machine available to sanitize the toys and classroom supplies.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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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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: 06/23/2022
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LPA Miranda observed facility supply of PPE COVID: supplies as gloves, hand sanitizing wipes, liquid hand sanitizer, cleaning wipes, children mask, adult masks, and thermometers.

During this inspection, Mr. Tran conducted an inspection and provided information about current COVID-19 resources and guidance.

No deficiencies are cited, per Title 22, Division 12, Chapter 3, of the California Code of Regulations.

An exit interview was conducted and a copy of this report (LIC 809) and Notice of Site Visit were provided to Director Assistant, Tori Hatch.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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