198020591-9-28-2021-33-CC-AEIN-C7APF4-20210928111606

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020591
Report Date: 09/28/2021
Date Signed: 09/28/2021 11:16:12 AM

Document Has Been Signed on 09/28/2021 11:16 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
CCLD Regional Office, 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: 5	DATE:	09/28/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Svetik Melkumyan, Licensee		TIME COMPLETED:	11:30 AM

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	Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection due to an incident that occurred on Wednesday, 09/22/2021. LPA arrived at the facility on 09/28/2021 at 8:40 a.m. and met with licensee, Svetik Melkumyan. During this inspection licensee's daughter, Ashkhen Bakhshyan was also present in the home who guided analyst of a tour of the facility. During this inspection there were 5 children present in the home, 4 being infants. Alleged Incident took place on 09/22/2021. Incident was reported via telephone next working day. Licensee's daughter, Ashkhen Bakhshyan stated she will email the written to Monterey Park Regional office at MPROincidentreports@dss.ca.gov by 09/29/2021. This is a one story home located on the first level which consists of consists of 3 bedrooms, 2 restrooms, living room, kitchen, laundry room, front yard, and backyard (fenced). Per licensee the children use the bathroom in the hallway, living room, kitchen, laundry room, and backyard (fenced). There is a fireplace in the living room to be covered to prevent access. Per licensee 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. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. Per Licensee's daughter, Ashkhen Bakhshyan at 9:00 a.m. her X-husband, Aleksandr Seyranov does not reside at this address and he was not listed on application form, LIC279 dated 06/15/2020. Per licensee's daughter, Ashkehn Bakhshyan her X-husband stopped by in the daycare address sometimes early in the mornings to pick up his son for the school while children were present. Per licensee's daughter, Ashkehen Bakhshyan her X-husband came to this home also from time to time in the evenings, after daycare hours, when children were not present and in the weekends. REPORT CONTINUES ON NEXT PAGE 1 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

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 2

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: 09/28/2021

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
26
27
28
29
30
31
32

Per licensee's daughter, Ashkehn Bakshyan she took out all her X-husband, Aleksandr Seryranov personal belongings from this address and granted a restraining order against Aleksandr Seyranov on 09/24/2021. LPA obtained a copy of restraining order. Per licensee's daughter, Ashkehn Bakshyan if any changes happen to restraining order terms and condition at any times she will provide a copy to LPA Eivazian. A written declaration obtained from licensee's daughter, Ashkhen Bakhshyan during this inspection.

At 9:35 a.m., Licensee's daugther, Ashkhen Bakhshyan took this LPA on a tour 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 and chairs, children toys, tables, chairs, napping cot and two pack 'n plays. 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. Per licensee's daughter parents use the main entrance door. LPA observed all electrical outlets were covered in living room. LPA observed there were five children present in the living room during this inspection. Next LPA toured the bathroom in the hallway of bedrooms and observed child proof safety latches on the under the sink cabinet. The restroom that children use was observed to be safe and sanitary. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. Per licensee, children walk through the kitchen and laundry room to go to the backyard (fenced). LPA observed a safety gate was installed to the kitchen to make it inaccessible to the children. Next LPA toured the three off-limit bedrooms and did not observe any hazards.

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 did not observe any objects that can pose a danger to children on the outdoor yard.

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.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Svetik Melkumyan and licensee's daughter, Ashkhen Bakhshyan at 11:30 a.m..

REPORT END 2 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2