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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001557
Report Date: 02/09/2022
Date Signed: 02/09/2022 02:58:58 PM


Document Has Been Signed on 02/09/2022 02:58 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:MELIKYAN, GAYANEFACILITY NUMBER:
384001557
ADMINISTRATOR:MELIKYAN, GAYANEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 672-4935
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY:14CENSUS: 6DATE:
02/09/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Melikyan GayaneTIME COMPLETED:
03:00 PM
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On February 9, 2022, Licensing Program Analyst (LPA) Van met with the Licensee, Gayane Melikyan, and her adult son for an unannounced inspection of the Plan of Correction (POC). Licensee's adult son was assisting with translation. The purpose of the inspection was explained, and was granted entry to the home of the Licensee. There are six children in care with the Licensee and a helper today (1 infant and five preschoolers). All staff have criminal record clearance on file.

On February 4, 2022, required annual inspection, the following deficiencies were cited:
1. Section 102370(d); The staff records review confirmed that Licensee's helper (S1) did not have criminal record clearance prior to working at the daycare. In today's inspection, the Licensee stated that S1 was no longer working at the daycare and provided a written Declaration Statement declaring that. During the visit, LPA did not observe S1 at the daycare. Section 102370(d) deficiency is cleared.
2. Section 102417(g)(9)(A)(1); Licensee did not document or keep a record of the fire and earthquake drill. Today, the Licensee showed proof of a log with the proper date and time of the fire and earthquake log. Section 102417(g)(9)(A)(1) deficiency is cleared.
3. Health and Safety Code section 1596.8662(b)(1); Licensee and helper (S1) did not have Mandated Reporting Training completed or on file. Today, Licensee provided proof of a completed Mandated Reporter Training completion. The completed date was February 6, 2022. Health and Safety Code section 1596.8662(b)(1) deficiency is cleared.

An exit interview was conducted with the Licensee, and a consultation was provided. In today's inspection, no deficiencies were observed. The Licensee, Gayane Melikyan, signed the report. Today's report, 2/9/2022, a notice of site visit, and a copy of the Letter of Deficiencies Citations will be sent to the Licensee email by the close of business on 2/9/2022. Confirmation of receipt is required.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2022
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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