198020591-7-12-2021-33-CC-AEIN-BRZQ98-20200730115755

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020591
Report Date: 07/30/2020
Date Signed: 07/12/2021 12:05:11 PM

Document Has Been Signed on 07/12/2021 12:05 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MELKUMYAN FAMILY CHILD CARE		FACILITY NUMBER:	198020591
ADMINISTRATOR:	SVETIK MELKUMYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 395-7471
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/30/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Svetik Melkumyan		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	PRELICENSING INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted a pre-licensing inspection today. LPA met with Svetik Melumyan, Applicant who guided analyst on a tour of the facility. Also during this inspection was present, Ashken Bakhsyan, applicant’s daughter. Family members residing in the home are 3 adults and 1 child. The applicant is requesting a large family child care home license. Per applicant operation hours will be Monday to Friday, 7:00a.m. to 6:00 p.m.. Applicant states she will care for children 0-12 years old. Previously applicant was licensed at 1050 Irving Avenue, #4, Glendale, CA 91201 with facility number, 198019307. Fire clearance for a large family child care was granted on 07/06/2020. All areas identified on the facility sketch were inspected. This is a one story home. The home consists of 3 bedrooms, 2 restrooms, living room, kitchen, laundry room, front yard, and backyard (fenced). Areas that are accessible to children are as follows: Bathroom in the hallway, living room, kitchen, laundry room, and backyard (fenced). Areas off limits based on facility sketch submitted to children and parents include: 3 bedrooms, one bathroom in the master bedroom, and front yard. Rooms that are off-limits need to be made inaccessible during operating hours Per applicant parents will enter the facility through the main entrance which leads to the living room. Per applicant children will use the backyard fenced for outdoor activity under direct supervision. The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. REPORT CONTINUES ON NEXT PAGE 1 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2020

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MELKUMYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020591
	VISIT DATE: 07/30/2020

NARRATIVE

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At 10:50 am, the applicant began touring LPA’s though the home starting with the entry way which lead directly to the living room, the living room was inspected and electrical outlets were observed to be covered. There is a fireplace in the living room which has been blocked off to prevent access to children. Next to the living room, The kitchen was inspected, and LPA observed a latch on the cabinet under the sink which stores cleaning compounds. The knives are stored in a cabinet out of reach for children. LPA advised that should the applicant have older children in care that may reach the cabinet, that they be secured. LPA observed the fire extinguisher purchased 10/01/2019, as read by LPA from the receipt. LPA observed Fire Extinguisher was anchored to the wall in the kitchen. Applicant also tested the carbon monoxide and smoke detector in the kitchen. Both sounded off the alarms and heard by LPA to be functional. There is emergency supplies in the closet in the living room. Next LPA toured off-limit 3 bedrooms and 1 bathroom in bedroom #2, bedroom #1 (applicant’s daughter’s bedroom), bedrooms#2 (applicant’s grandchildren’s’ bedroom, and bedroom #3 (applicant’s bedroom) and did not observe any hazardous. Next LPA inspected the bathroom in the hallway that children will use, and LPA observe a safety latch on the cabinet under the sink where applicant stores cleaning compounds and shampoos. Next LPA inspection laundry room and backyard (fenced) and did not observe any hazards. Per applicant, children only use the kitchen and laundry room to go to the backyard.

At 11:40 am the applicant states that they will provide food for children in care. If food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated. Per applicant, there are no pets, firearms, body of water and weapons on the premises. There are toys available for children.

Applicant has proof of CPR and First Aid training as indicated on the certificate. The applicant does have proof of Health and Safety training (completion date:01/28/2017), Pediatric First Aid and CPR (ex.12/2020).

The following was discussed with the applicant:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

REPORT CONTINUES ON NEXT PAGE 2 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2020

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MELKUMYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020591
	VISIT DATE: 07/30/2020

NARRATIVE

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-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.
-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
-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)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
- No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
-All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
Infant Care: Applicant states that she does care for infants. LPA advised the applicant to sleep infants where they can be directly supervised at all time. LPA advised the applicant to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. The applicant states that she will not sleep infants in a separate room. Applicant stated at 11:50 am, infants will sleep in the living room under direct supervision. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were provided.

REPORT CONTINUES ON NEXT PAGE 3 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2020

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MELKUMYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020591
	VISIT DATE: 07/30/2020

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Medication: Incidental Medical Services (IMS) policy was discussed .For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.Per applicant, she carries liability insurance with standard established by Family Child Care statue.
The applicant does not have proof of immunization against influenza, pertussis, and measles.
Applicant is exempt from Mandated Reporter training at this time due to language barrier.

LPA consulted and explained Child Abuse Reporting, Effects of Lead Exposure Flyer, Updated Patent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) was provided during this inspection.

LPA advised the applicant how to access forms, regulations and quarterly updates, and Provider Information Notices (PIN) on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:
CHILDREN FORMS/RECORDS , FACILITY FORMS/RECORDS , INFORMATION TO BE POSTED IN YOUR FAMILY CHILD CARE HOME

A large family child care license will be granted upon receipt of proof of corrections for the above. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.
The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.
Exit interview was conducted with Svetik Melkomyan, Applicant at 12:00 pm, who is in agreement with the above.
REPORT END 4 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2020

LIC809 (FAS) - (06/04)

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