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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020591
Report Date: 11/05/2021
Date Signed: 11/05/2021 11:49:48 AM

Document Has Been Signed on 11/05/2021 11:49 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 CAREFACILITY NUMBER:
198020591
ADMINISTRATOR:SVETIK MELKUMYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 395-7471
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 5DATE:
11/05/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Svetik Melkumyan, LicenseeTIME COMPLETED:
12:00 PM
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***CASE MANAGEMENT INSPECTION CONDUCTED IN ARMENIAN***
An unannounced Case Management inspection was conducted on 11/05/2021 at 10:00 a.m. by Licensing Program Analyst (LPA) Anomeh Eivazian to provide the following letter regarding Aleksandr Seyranov:
  • ORDER TO INDIVIDUAL OF IMMEDIATE EXCLUSION FROM ALL FACILITIES

Upon arrival LPA Eivazian met with Licensee, Svetik Melkumyan and the nature of the inspection was discussed. During this inspection Ashkhen Bakhshyan, licensee's daughter and Arpine Hovsepyan, licensee's assistant were also present in the home. LPA observed 5 children were playing in the living room during this inspection.
LPA advised Licensee that as of November 5, 2021, Aleksandr Seyranov is excluded from Melkumyan Family Child Care and any other facility licensed by Department of Social Services. Licensee was advised that the immediate exclusion letter is a public document. The licensee was advised of the appeal process for this exclusion.
The licensee was advised that the following parent notifications are required for an excluded individual:
• Provide a copy of the Addendum to Notification of Parent's Rights (Regarding Removal/Exclusion) (LIC 995B Rev. 05/03) to one parent or authorized representative of every child currently in care within one day of receipt of the addendum from the Department.
• Obtain a signed and dated receipt from one parent or authorized representative that acknowledges that he/she was given a copy of the addendum specified in 102370.1(b)(2) and (2)(A). (LIC995B)
• Maintain copies of the signed and dated receipt (LIC995B) as required in Section 102370.1(b)(3) in each child's file. Copies shall be made available to the Department upon request.
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 at 12:00 p.m..
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
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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