198020591-12-22-2021-33-CC-AEIN-C9XQ7G-20211222105506

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020591
Report Date: 12/22/2021
Date Signed: 12/22/2021 10:55:14 AM

Document Has Been Signed on 12/22/2021 10:55 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: 9	CENSUS: 0	DATE:	12/22/2021
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Svetik Melkumyan, Licensee		TIME COMPLETED:	11:00 AM

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Licensing Program Manager (LPM) Christina Gabelman and Licensing Program Analyst (LPA) Anomeh Eivazian met with licensee Svetik Melkumyan and licensee’s daughter Ashkhen Bakhshyan. The purpose of this office meeting is to review and discuss cited deficiencies and concerns with the operation of this licensed facility and order of Immediate Exclusion order for Aleksandr Seyranov from Melkumyan Family Child Care and any other facility licensed by Department of Social Services as of November 5, 2021. LPM Gabelman reviewed and discussed the departments concerns with the licensee and how they will maintain compliance with the deficiencies cited below which were reviewed by LPM Gabelman. LPA Eivazian reviewed the plan of correction items to ensure they will maintain compliance and meet the Title 22 regulations. The licensee has implemented a plan of correction since deficiencies were cited. Some parts of this meeting was translated to Armenian by LPA Eivazian.

Deficiencies were issued from 10/21/2021 to 11/05/2021:

1. LPM Gabelman advised Licensee that as of November 5, 2021, Aleksandr Seyranov was 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. Per licensee's daughter, Ashken Bakhshyan, Aleksandr Seyranov is not residing in the facility address anymore and he is not coming in the facility address. Per licensee's daughter, Aleksandr Seyranov lives in City of Burbank but does not have his actual address. He does not come to the facility anymore and has a retraining order against him even though he has not taken the paperwork but he is aware of the order.

2. Staffing Ratio and Capacity:
- Type A, 10/21/2021: LPA Eivazian observed on 10/21/2021 there were total of 8 children present in the facility, 5 being infants. Licensee was observed not operating within her license limitation and was over ratio by one infant.

REPORT CONTINUES ON NEXT PAGE 1 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

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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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: 12/22/2021

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3. Reporting Requirements:
- Type A, 11/05/2021: Based on interviews that were conducted during the complaint investigation, Aleksandr Seyranov referred to facility address as his resident. Detectives observed Aleksandr Seyranov personal belongings in the facility, and he was present in the facility on 09/21/2021 and 09/22/2021 while daycare children were in care.

4. Revocation or Suspension of a License or Registration:
- Type A, 11/05/2021: Based on interviews that were conducted with detectives, Aleksandr Seyranov referred to the facility address as his resident and detectives observed Aleksandr Seyranov's belonging in the facility on 09/22/2021 as well as his presence in the home.

Compliance Plan:

1. Licensee will submit in writing what they learned from CCLD training videos and how they will apply what they learned from the video(s) in daily operation by 01/21/2022.https://cdss.ca.gov/inforesources/child-care-licensing. Licensee will watch the below videos:
· Child Care Reporting Requirements
· Background Check Requirements for Caregivers
· Supervising Children in Family ChildCare
· How Many Children Can Attend a Family Child Care Home?

2. Licensee will be placed on frequent required inspections for 2 years, bi annually (twice a year), to ensure compliance.

LPA Eivazian reminded licensee to follow COVID protocol to ensure Health and Safety of children in care.

Failure to maintain compliance may result in the department taking administrative action against the facility.

Exit interview conducted and report was reviewed with the Licensee, Svetik Melkumyan at 11:00 a.m.

REPORT END 2 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC809 (FAS) - (06/04)

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