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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020591
Report Date: 08/18/2025
Date Signed: 08/18/2025 12:43:44 PM

Document Has Been Signed on 08/18/2025 12:43 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MELKUMYAN FAMILY CHILD CAREFACILITY NUMBER:
198020591
ADMINISTRATOR/
DIRECTOR:		SVETIK MELKUMYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 395-7471
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
08/18/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Svetik Melkumyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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ANNUAL/RANDOM INSPECTION CONDUCTED IN ARMENIAN

Licensing Program Analyst (LPA) Anomeh Eivazian conducted an Annual/Random unannounced inspection to the above facility on 08/18/25. LPA arrived at the facility at 11:15 AM and met with Ashkhen Bakhshyan, licensee's daughter/assistant who guided analyst on a tour of the facility. Also present during this inspection, were Svetik Melkumyan, licensee, Arusvak Bakhshyan, licensee's daughter/assistant and Karine Arakelyan, Licensee’s Assistant. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee. Per licensee, facility hours are Monday to Friday from 7:30 a.m. to 5:30 p.m.. Per licensee, she provides care to children 0-13 years old.

This is a one story home located on the first level. The home consists of 3 bedrooms, 2 restrooms, living room, kitchen, laundry room, front yard, and backyard (fenced). Per licensee's daughter, Ashkhen Bakhshyan, parents enter the home through the main entrance door which leads to the living room or side gate which leads to the backyard.

Per licensee's daughter, Ashkhen Bakhshyan the children use the bathroom in the hallway, living room, kitchen, laundry room, and backyard (fenced). Per Ashkhen Bakhshyan, licensee's daughter areas off limits to children and parents include: 3 bedrooms, one bathroom in the master bedroom, and front yard. LPA did not observe any stairs in the home. There is a gate in the backyard which leads to the back building. Per licensee, the residents in the back building do not use the side gate for their commute during daycare hours. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 11:20 a.m., Licensee's daughter, Ashkhen Bakhshyan took this LPA on a tour


REPORT CONTINUES ON NEXT PAGE 1 of 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 08/18/2025
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of the home. LPA was toured through the interior starting with the living room (daycare classroom), LPA observed sofas, a coffee table, a TV, adult dining table, chairs, children’s toys, tables, chairs, and napping cots. There is a fireplace in the living room which has been covered to prevent access. There is a screen door with (2) locks on the front entrance. In addition, the wrought iron railings and openings leading to front door are covered with mesh. LPA observed all electrical outlets were covered in the living room. Next LPA toured the bathroom in the hallway of bedrooms and observed child proof safety latches on the cabinet under the sink. The restroom that children use was observed to be safe and sanitary. LPA observed two off-limit bedrooms doors were closed during this inspection. LPA observed plastic doorknobs on off-limit bedrooms door knobs. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. LPA observed a safety gate was installed in the kitchen. Per licensee, children walk through the kitchen and laundry room to go to the backyard (fenced). LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the kitchen. It was serviced on 04/20/25 as read by LPA from the service tag. Licensee's daughter, Ashkhen Bakhshyan tested the carbon monoxide and smoke detectors in the kitchen. It sounded off the alarms and heard by LPA to be functional. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee's daughter states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

Next LPA toured the backyard fenced. Currently, children are using the back yard for outdoor play time. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA observed 6 children were playing outside with licensee's two assistants. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided. The outdoor yard ground is covered with artificial grass.

Per Licensee, at 12:30 p.m there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.

The licensee and her assistant have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 05/2025, Licensee's daughter/assistant, Arusyak Bakhshyan Pediatric First Aid and CPR expires on 05/2027. Licensee’s daughter/assistant, Arusvak Baskhshyan Pediatric First Aid and CPR expires on 04/2027. Licensee is exempt from required mandated reporter training due to language barrier, she is an Armenian speaking provider. There are first aid supplies available on the premises in a closet in the living room. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.


REPORT CONTINUES ON NEXT PAGE 2 of 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: 08/18/2025
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The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection there were 6 children present in the home, with licensee and her two assistants. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she has three assistants. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

At 12:40 p.m., the facility roster was reviewed and completed. Per licensee currently there are 7 children enrolled. LPA reviewed 6 children's records, and all 6 reviewed files were completed. The licensee and her assistants have proof of immunization against influenza, pertussis, and measles. 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 06/16/25.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. There is telephone service via a landline stays at the facility during operation hours. Per licensee she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) on six reviewed files.

Medication: Incidental Medical Services (IMS) policy was discussed at 12:50 p.m. The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.


REPORT CONTINUES ON NEXT PAGE 3 of 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 08/18/2025
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INFANT CARE: Licensee states that she is currently caring for infants. Per licensee, currently she does not have an infant enrolled in her daycare. Licensee states that infants sleep in the living room where they are constantly supervised. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date.

SAFE SLEEP: LPA discussed the safe sleep regulations with licensee, and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Boppy recall: https://www.cpsc.gov/Recalls/2021/The-Boppy-Company-Recalls-Over-3-Million-Original-Newborn-Loungers-Boppy-Preferred-Newborn-Loungers-and-Pottery-Barn-Kids-Boppy-Newborn-Loungers-After-8-Infant-Deaths-Suffocation-Risk

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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.


Licensee, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
During the exit interview, the Licensee, Svetik Melkumyan confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
Exit interview conducted and report was reviewed with the licensee, Svetik Melkumyan
REPORT END 4 of 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5