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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020855
Report Date: 10/14/2022
Date Signed: 10/14/2022 03:10:15 PM

Document Has Been Signed on 10/14/2022 03:10 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:MELKONYAN FAMILY CHILD CAREFACILITY NUMBER:
198020855
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
10/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Lilit Melkonyan, LicenseeTIME COMPLETED:
03:20 PM
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ANNUAL INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual and case- management licensee initiated inspections to the above facility on 10/14/2022 due to licensee is requesting capacity increase. LPA arrived at the facility at 12:55 PM and met with Lilit Melkonyan, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Syuzana Hovhannisyan, Licensee’s Daughter. Per licensee, Lilit Melkonyan facility hours are Monday to Friday from 7:00 a.m. to 10:00 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee.
Fire Clearance for Large Family Child Care Home was granted on 09/28/2022.

This is a one story home located on the first level. The home consists of 3 bedrooms, 2 restrooms, living room, family room, kitchen, front yard (fenced), backyard, and detached garage. Per licensee at 1:10 p.m. the children use the bathroom in the master bedroom, living room, family room, master bedroom, and front yard (fenced). Per licensee areas off limits to children and parents include: Kitchen, two bedrooms, one bathroom in the hallway, backyard (fenced) and detached garage. LPA did not observe 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.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 1:20 p.m., the licensee began touring LPA’s through the home starting with the entry way which lead directly to the living room. The living room was inspected and electrical outlets were observed to be covered. There is a fireplace and a short wall heather/AC in the living room which have been blocked off to prevent access to children. LPA observed sofas, a coffee table, an adult dining table, dining chairs in the living room. Next to the living room, The Family room was inspected, and LPA observed all electrical outlets were covered. LPA observed children toys, chairs and tables in the Family room. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores cleaning
REPORT CONTINUES ON NEXT PAGE 1 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2022
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
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: MELKONYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020855
VISIT DATE: 10/14/2022
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compounds and sharp times. LPA observed a safety gate was installed to the kitchen to make the kitchen and laundry room inaccessible to the children. Per licensee no poisons are kept in the home. Next LPA toured the two off-limit bedrooms and one off-limit bathroom in the hallway and did not observe any hazards. LPA observed licensee's family members personal belongings in the home. Next LPA toured the master bedroom and observed 4 children napping in the bedroom. Next LPA toured the bathroom in the master bedroom and observed short wall heather/AC in the daycare bathroom was screened to prevent access and it is locked. There is door in the master bedroom which leads to the backyard. Per licensee, she keeps that door locked all the times. LPA observed a plastic door knob and chain lock on the master bedroom door which leads to the backyard. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the kitchen. It was serviced on 07/28/22 as read by LPA from the tag. Licensee tested the carbon monoxide detector in the family room and smoke detector in the master bedroom. Both 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. There are emergency supplies available in the home in the laundry room.

Next LPA toured the off-limit backyard fenced and off-limit garage and did not observed any hazards.
Per licensee, children will use the front yard (fenced) for outdoor play time. The outdoor play area was observed to be fenced with four feet high fencing. 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 outdoor playarea ground is turf. The licensee states that supervision will be always provided.

Per Licensee, Lilit Melkonyan at 2:00 p.m there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.


REPORT CONTINUES ON NEXT PAGE 2 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
Page: 2 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: MELKONYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020855
VISIT DATE: 10/14/2022
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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. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently her two daughters assists her. 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.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 02/2023. Licensee, Lilit Melkonyan completed required mandated reporter training on 02/11/2021. There are first aid supplies available on the premises in the licensee's bedroom. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 2:10 p.m., facility roster was reviewed and completed. Per licensee currently there are 5 children enrolled. LPA reviewed 5 children's records, including emergency information from 5 enrolled children, and all 5 reviewed files were completed.

The licensee has 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 09/01/2022.

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 cellphone that is used and the cellphone 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 5 reviewed files.


REPORT CONTINUES ON NEXT PAGE 3 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
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: MELKONYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020855
VISIT DATE: 10/14/2022
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INFANT CARE: Licensee states that she is currently caring for two infants. Licensee states that infants sleep in the daycare bedroom where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (one crib for each infant in care was observed). Cribs or play yard did not hinder the entrance or exit from the sleeping space bedroom, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPA did/did not observe any infants swaddled while in care. 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. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

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
Medication: Incidental Medical Services (IMS) policy was discussed. The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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 4 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
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: MELKONYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020855
VISIT DATE: 10/14/2022
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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.

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.

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

Exit interview conducted and report was reviewed with the Licensee, Lilit Melkonyan at 3:20 p.m..


REPORT END 5 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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