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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020591
Report Date: 04/08/2024
Date Signed: 04/08/2024 10:26:37 AM

Document Has Been Signed on 04/08/2024 10:26 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/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
04/08/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Svetik Melkumyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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ANNUAL/REQUIRED INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an Annual/required unannounced inspection to the above facility on 04/08/24. An office meeting was held with licensee on 12/22/2021 and facility was placed on required inspections for two years. LPA arrived at the facility at 8:35 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. Per licensee, facility hours are Monday to Friday from 7:30 a.m. to 5:30 p.m.

This is a one story home located on the first level which consists of 3 bedrooms, 2 restrooms, living room, kitchen, laundry room, front yard, and backyard (fenced).

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. Per licensee's daughter, Ashkhen Bakhshyan, parents enter the home through the main entrance door which leads to the living room. 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 8:50 a.m., Licensee's daughter, 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, and napping cots. There is a fireplace in the living room which had been covered to prevent access.
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2024
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 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: 04/08/2024
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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 living room. LPA observed five children were present in the living room playing with licensee's two assistants. 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 door were closed during this inspection. LPA observed plastic door knobs 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 to 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 02/27/24 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 did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided. Outdoor yard ground is covered with artificial grass.

Per Licensee, at 9:50 a.m there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.

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 5 children present in the home, one being infant with licensee and her three 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.
REPORT CONTINUES ON NEXT PAGE 2 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
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: 04/08/2024
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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 04/2025. 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.

At 10:00 a.m., facility roster was reviewed and completed. Per licensee currently there are 8 children enrolled. LPA reviewed 8 children's records, and all 8 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 03/01/24.

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 four reviewed files.

Medication: Incidental Medical Services (IMS) policy was discussed at 2:00 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
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
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: 04/08/2024
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INFANT CARE: Licensee states that she is currently caring for infants. Per licensee, currently there is one infant enrolled in her daycare who will turn two years old in September 2024. 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 experienced. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding inspection tools and methods, please visit the Program website at www.cdss.gov/inforesouces/community-care-liceinsing/inspection-process

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


Exit interview conducted and report was reviewed with the Licensee's daughter, Ashkhen Bakhshyan and Svetik Melkumyan, licensee at 10:40 a.m.
REPORT END 4 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
LIC809 (FAS) - (06/04)
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