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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700063
Report Date: 11/15/2023
Date Signed: 11/15/2023 01:11:07 PM

Document Has Been Signed on 11/15/2023 01:11 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MELVIN FAMILY CHILD CAREFACILITY NUMBER:
157700063
ADMINISTRATOR:CHUNTE MELVINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 754-4394
CITY:CALIFORNIA CITYSTATE: CAZIP CODE:
93505
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
11/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Chunte MelvinTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Carol Heath met with the Licensee, Chunte Melvin, for a case management incident inspection involving an Unusual Incident Report (UIR) received by telephone on 11/13/2023. LPA toured the facility and took a census of the children. Upon arrival, there were 2 children and 2 staff present today.

Description of the incident: An incident occurred on 11/13/2023. PRO Officer of the Day (OD) received a telephone call from the licensee stating child #1’s mother called the Licensee and that the child had a bump and bruise on her forehead. C1 was trying to sit on a couch; C1 fell backward and hit her head on the TV cabinet. The licensee did not observe any bruises or swelling. During today (11/5) visit, the child #1 is attending the facility.

LPA received the facility roster and reviewed child #1’s file.

Based on the information provided, further investigation is needed at this time. An exit interview was conducted, and a copy of the report was read and provided to the licensee, Chunte Melvin.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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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