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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609337
Report Date: 02/24/2023
Date Signed: 02/24/2023 11:32:56 AM

Document Has Been Signed on 02/24/2023 11:32 AM - 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:MOLOCK RESIDENTIAL IIFACILITY NUMBER:
197609337
ADMINISTRATOR:MONICA VARTANIANFACILITY TYPE:
735
ADDRESS:43140 E 33RD STREETTELEPHONE:
(661) 674-8592
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
02/24/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monica Vartarian, AdministratorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Shira Stamp arrived at the facility above at approximately 10:00am for a case management visit. The Administrator, Monica Vartarian, arrived around 10:30am. The purpose of this visit is to address the two (2) year compliance plan. Entrance interview conducted with the Administrator.

Today’s focus was infection control, training for new staff, and sufficient staffing for supervision. LPA conducted a physical plant tour and conducted a record review of staff training files. All clients were currently in their day programs. The HVAC/air conditioning system is working, and the facility maintains a comfortable temperature of 70 degrees F. LPA observed heat/weather related signs posted throughout the facility. LPA reviewed the LIC 500 and found there to be sufficient staff for each shift. LPA reviewed the staff training files regarding heat related training and care and supervision, and LPA verified that all staff have completed this training. At 11:15am, LPA collected training documents regarding care and supervision and heat related training. LPA observed sufficient water supply for all clients. LPA observed staff following current infection control requirements, such as wearing masks, screening visitors, asking infection control questions, and having COVID signs posted throughout the facility.

Exit interview conducted. Copy of report delivered to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
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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