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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416983
Report Date: 12/21/2023
Date Signed: 12/21/2023 11:23:41 AM

Document Has Been Signed on 12/21/2023 11:23 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MELIKSETYAN FAMILY CHILD CAREFACILITY NUMBER:
197416983
ADMINISTRATOR:MELIKSETYAN, NAIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 206-7624
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY: 12TOTAL ENROLLED CHILDREN: 15CENSUS: 10DATE:
12/21/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:13 AM
MET WITH:Naira Meliksetyan TIME COMPLETED:
11:30 PM
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 Licensing Program Analyst (LPA) Shushanik Safaryan and Licensing Program Manager Claudia Guangorena conducted an unannounced required 3-year inspection to the above facility on 12/21/23 at 08:15 am . A COVID 19 risk assessment was conducted upon entry. Licensing staff met with Licensee, Naira Meliksetyan to whom the reason for the visit was explained. Per Licensee, there are 15 children currently enrolled. There were no children present upon arrival . Around 08:30 one child arrived and Licensee assistant. During the inspection 7 more children arrived. The licensee was observed to be operating within the license capacity limitations.

The licensee states only 1 adult and no children currently live in the home; names noted on Confidential Name List (LIC 811).All adults living in the home have obtained a criminal record clearance.

This is a one story home which consists of 2 bedrooms, 2 bathrooms, living room, dining room, kitchen, den and backyard which is fenced.

Care is provided in the living room, dining room, 1 bedroom, den , 1 bathrooms and backyard. Per licensee parents enter the home through the main entrance which leads to the living room. Licensing staff reminded Licensee that parents have a right to enter and inspect the family childcare home whenever children in care.

Per licensee, areas off limits to children and parents include Licensees bedroom and 1 bathroom, kitchen . Licensing staff reminded licensee areas/rooms that are designated to be off limits need to be inaccessible to the children all the time.

During this visit, all areas identified that are accessible for children to use were inspected for the safety, comfort, and cleanliness. Facility sketch was updated on 12/21/2023 by Licensee during the inspection. At 08:15 am Licensee guided Licensing staff on a the tour of the home. Licensing staff was toured starting from the living room, where Licensing staff observed children’s toys, tables , chairs , children cubbies. Next staff toured the dinning room and observed children’s toys, tables, chairs, children's piano. Per licensee living room and dining room used for activities only. After Licensing staff toured hallway where Licensee had a child proof gate blocking access to the kitchen. In the kitchen Licensing staff observed required 2-A-10-B-C fire extinguisher .The valve on the required 2-A-10-B-C fire extinguisher indicates fully charged. Licensee was not able to provide receipt with a purchase date. Smoke and carbon monoxide detectors were tested and are operable. Page 1 of 5
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MELIKSETYAN FAMILY CHILD CARE
FACILITY NUMBER: 197416983
VISIT DATE: 12/21/2023
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Licensing staff toured the bathroom, which was for adult use, Licensing staff reminded that if it is off limit area, needs to have child proof lock. From the hallway Licensing staff toured children’s sleep area where licensing staff observed 9 cots and one more in the den. From the napping area children have access to the children`s bathroom. Licensing staff observed children bathroom and did not observe anything that could pose danger . During the tour Licensing staff observed open face heater on the floor in wall which could pose a danger for the children in care. From the den children have access to the backyard .

Licensing staff observed the following required posted documentation in the main entry way in the living room of the home. Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Licensing staff reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 12/02/2023.



There is telephone service via Licensee`s and assistant's cellphone that stays at the facility during operation hours. Per Licensee parents know both numbers. Hours of operation are Monday – Friday, 07:45 am – 6:00 pm. There is central air in the home.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee, there are no poisons in the home. Licensing staff advised that any poisons should be locked under key or combination lock. Licensee states that there are no firearms or weapons stored in the home.

The home is observed to be clean and orderly. There are first aid supplies available in the kitchen . There are age-appropriate toys available for children.

Per licensee, she provides food for children in care. Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated.

Currently, children are using the backyard for outdoor play time. The outdoor play area was observed to be fenced and gated. Licensing staff observed that the outdoor yard has toys and other materials for children to play with. Licensing staff did not observe any objects that can pose danger to children. Licensing staff observed storage area in the yard that had children toys. No bodies of water were observed on this day.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MELIKSETYAN FAMILY CHILD CARE
FACILITY NUMBER: 197416983
VISIT DATE: 12/21/2023
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Staff and Licensee files were reviewed for the following: LIC 508- Criminal Record Statement, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. Pediatric First Aid and CPR certification on expires 08/2024 for licensee & Licensee’s assistant. Licensing staff advised licensee First Aid and CPR training must be taken in person with an EMSA approved vendor.

Mandated Reporter Training for licensee has been completed on 06/29/2019 and expires on 06/29/2021. Licensees assistant did not had any proof for the completion of the training. Licensing staff reminded licensee to renew training every two years at www.mandatedreporterca.com.

Children’s records were reviewed for Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627-Consent for Medical Treatment and LIC 995A- Notification of Parent's Right`s . Licensing staff observed files to be complete. Per licensee she carries liability insurance .
Licensee states she is currently caring for 1 infant. Licensing staff did not observe a sleep log in the child’s record .

Licensing staff created an LIC 857, Children’s Record Review, and LIC 811 for Staff Record Review which documents staff and children’s files reviewed during this inspection.

Per licensee, there are no animals on the premises, none observed .

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Licensing staff did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family childcare facility.
Licensing staff discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

Licensing staff also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MELIKSETYAN FAMILY CHILD CARE
FACILITY NUMBER: 197416983
VISIT DATE: 12/21/2023
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Incidental Medical Services (IMS) policy was discussed. Licensee does not provide IMS right now. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at ww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee was reminded ,any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (Use LIC624B for written report). The on Duty Worker is available for questions Monday through Friday at (323) 981-3350 from 8:00 AM - 5:00 PM.

Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.



During the exit interview, the Licensee Naira Meliksetyan confirmed that there are no Registered Sex Offenders living in the facility and LPA Safaryan completed the RSO profile in FAS.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MELIKSETYAN FAMILY CHILD CARE
FACILITY NUMBER: 197416983
VISIT DATE: 12/21/2023
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Based on Licensing staff observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Licensing staff informed licensee naira Meliksetyan that this report dated 12/21/23 shall be posted for 30 consecutive days as there are immediate risk(s) to the health, safety, or personal rights of children in care.


A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Exit interview conducted and report was reviewed with the licensee Naira Meliksetyan .

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 12/21/2023 11:23 AM - It Cannot Be Edited


Created By: Shushanik Safaryan On 12/21/2023 at 10:20 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MELIKSETYAN FAMILY CHILD CARE
FACILITY NUMBER: 197416983

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above . LPA observed open face floor heater accesible to the children which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/11/2024
Plan of Correction
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Licensee will block the heater so children won't be able to touch it and email photos to the LPA by POC Date .
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and record review, the licensee did not comply with the section cited above . LPA observed that Mandated Reporter Certificate expires on 06/29/2019 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/11/2024
Plan of Correction
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Licensee and assistant will take the training and email certificates to the LPA by POC date .
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claudia Guangorena
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 12/21/2023 11:23 AM - It Cannot Be Edited


Created By: Shushanik Safaryan On 12/21/2023 at 10:20 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MELIKSETYAN FAMILY CHILD CARE
FACILITY NUMBER: 197416983

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(a)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Date.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above. LPA did not observe sleep log in the infant file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/28/2023
Plan of Correction
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Licensee will start checking on infant every 15 minutes and log in the sleeping log and will email the copy to the LPA by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claudia Guangorena
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023


LIC809 (FAS) - (06/04)
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