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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004136
Report Date: 02/06/2025
Date Signed: 02/06/2025 04:46:33 PM

Document Has Been Signed on 02/06/2025 04:46 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MELIKSETYAN, FLORAFACILITY NUMBER:
384004136
ADMINISTRATOR/
DIRECTOR:		MELIKSETYAN, FLORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 606-0525
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
02/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Licensee, Flora MeliksetyanTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On 2/6/2025, at approximately 2:45PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Flora Meliksetyan, and explained the purpose of the visit. Present during the visit was Licensee, a helper, five preschool age children and two infants. The facility’s operating hours are from 8:00AM to 5:30PM, Monday to Friday.

Daycare Areas: Lower Level: Office, Family Room, Den, Bathroom, and Backyard.
Off-limits Areas: Entire upper level. Lower Level: Lower Master Bedroom, Master Bathroom, and Sauna located in Bathroom.

LPA and Licensee inspected the home for any health or safety hazards. The home is equipped with a fully charged 2A10BC fire extinguisher. There is a carbon monoxide detector in the Family Room. There is a fire alarm system running throughout the facility. LPA observed smoke detectors to be present in the daycare areas. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. Stairs are kept inaccessible to children with a childproof gate. There are heating and ventilation controls available for the comfort and safety of children in care. Electrical outlets are covered or blocked with furniture when not in use.

LPA observed there to be age-appropriate toys and learning materials available for children. Furniture is age-appropriate and free of rough or sharp edges. There are cubbies available for each child that are labeled. Children use cribs or cots for napping. LPA advised that cribs shall be kept free of all loose articles or objects. No baby walkers were observed to be present during today’s visit. Children bring water bottles from home and refill them at the facility.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MELIKSETYAN, FLORA
FACILITY NUMBER: 384004136
VISIT DATE: 02/06/2025
NARRATIVE
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The Backyard was observed to be free of debris and other loose articles. There are age-appropriate toys and equipment available. The Backyard is enclosed by a fence that is at least four feet high. There are no swimming pools or other similar bodies of water present. Per Licensee, there are firearms in the home that are kept inaccessible to children in an off-limits area.

LPA reviewed two staff files, five children’s files, and facility records. Licensee’s Pediatric First Aid/CPR is current and expires 5/2026. Licensee’s Mandated Reporter Training is current and expires 5/2026. All adults living or working in the home have acquired fingerprint clearance and are associated to the facility. The facility roster was made available for review during the visit. Children’s files were observed to be complete. Infant sleeping logs were not available for review. LPA informed Licensee that a deficiency would be cited during today's visit. LPA observed all required postings to be posted and accessible for review immediately upon entry to the facility. The facility last conducted an emergency drill in 11/2024. LPA advised that drill logs be kept on the same document for ease of access.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.





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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MELIKSETYAN, FLORA
FACILITY NUMBER: 384004136
VISIT DATE: 02/06/2025
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LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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 https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC809-D for deficiency cited today regarding infant sleeping logs. Appeal rights were provided and explained to Licensee. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Flora Meliksetyan.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/06/2025 04:46 PM - It Cannot Be Edited


Created By: Jonathan Tse On 02/06/2025 at 04:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MELIKSETYAN, FLORA
FACILITY NUMBER: 384004136

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above by not maintaining which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2025
Plan of Correction
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Licensee shall begin documenting infant sleep logs and submit proof of logs for napping infants to LPA via email by set due date of 3/6/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ali Zebila
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2025


LIC809 (FAS) - (06/04)
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