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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609337
Report Date: 10/13/2023
Date Signed: 10/13/2023 11:59:45 AM


Document Has Been Signed on 10/13/2023 11:59 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: 3DATE:
10/13/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Monica Vartanian, Adminitrator TIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Angela Panushkina, Huma Rahimi, Lorena Casillas and Leslie Ngo-Castaneda arrived at the facility above at approximately 10:10am for a case management visit. The Administrator, Monica Vartarian, arrived around 10:40am. The purpose of this visit is to address the two (2) year compliance plan. Entrance interview conducted with the Administrator.

Administrator informed LPAs that all clients were currently in their day programs.

Today’s focus was infection control, training for new staff, and sufficient staffing for supervision. LPAs conducted a physical plant tour and observed the facility maintains a comfortable temperature of 72°F. LPAs also observed heat/weather related signs posted throughout the facility. LPAs reviewed the LIC500 (Personnel Report) and found there to be sufficient staff for each shift. LPAs also reviewed the staff training files regarding heat related training and care and supervision. LPAs verified that all staff have completed this training. At 11:50am, LPAs collected training documents regarding care and supervision and heat related training. Lastly, LPAs observed sufficient water supply for all clients.

Exit interview conducted. Copy of this report is signed and delivered.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
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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