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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202620
Report Date: 06/22/2023
Date Signed: 06/22/2023 03:02:31 PM

Document Has Been Signed on 06/22/2023 03:02 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,
, CA
FACILITY NAME:MANUCH INC- ASPEN HOUSEFACILITY NUMBER:
107202620
ADMINISTRATOR:FOUNTAIN, GARNETTFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6CENSUS: 3DATE:
06/22/2023
TYPE OF VISIT:Case Management - Law Enforcement ContactsANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Levon Manucharyan, AdministratorTIME COMPLETED:
03:15 PM
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Licensing Program(LPA) Corina Carrillo and Licensing Program Manager Angela King(LPM) conducted a case management inspection June 22, 2023 at 11:05 AM, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of 15 Direct Care Staff and 3 out of 3 youth files were reviewed. 2 out of 5 Direct Care Staff and 0 out of 3 youth were interviewed. (See the Confidential Names List, LIC 811, June 22, 2023.) The Plan of Operation including policies and procedures were reviewed.

Based on the analysis of the confidential interviews and youth file review including the needs and service assessments and crisis intervention plans, the licensee uses trauma- informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline.

LPA Carrillo and LPM King observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others.

There are no deficiencies cited at this time. A copy of this report was discussed and provided to Levon Manucharyan.

SUPERVISORS NAME: Angela King
LICENSING EVALUATOR NAME: Corina Carrillo
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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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