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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700063
Report Date: 10/01/2026
Date Signed: 10/01/2026 10:47:19 AM

Document Has Been Signed on 10/01/2026 10:47 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MELVIN FAMILY CHILD CAREFACILITY NUMBER:
157700063
ADMINISTRATOR/
DIRECTOR:		CHUNTE MELVINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 754-4394
CITY:CALIFORNIA CITYSTATE: CAZIP CODE:
93505
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/01/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Chunte Melvin, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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On 10/01/2026, Licensing Program Analyst (LPA) Sara Rajapakse conducted a subsequent case management visit to conclude the investigation regarding a self-reported Unusual Incident received on 08/17/2026. Upon arrival, LPA met with Licensee Chunte Melvin. LPA observed 11 children in care.

The investigation included interviews with the Licensee, children, and other relevant parties, as well as a review of medical records, equipment manuals, and facility documents.

The investigation determined that on 08/17/2026, the Licensee’s assistant allowed Child #1 to utilize play equipment that was not age-appropriate, resulting in Child #1 sustaining an injury. Child #1’s guardian obtained medical treatment, and the discharge diagnosis was a head contusion.

Based on observations, interviews, medical records, equipment manual review, and record review, a Type A deficiency is cited pursuant to CCR Title 22, Section 102423(a)(2): To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. See LIC 809-D for citation.

The deficiency must be corrected to ensure the health and safety of children in care. A copy of this report shall be provided to all current parents/guardians by the next business day or upon the child’s return. The report must also be provided to parents/guardians of newly enrolled children for the next 12 months. A signed LIC 9224 shall be maintained in each child’s file.

A Notice of Site Visit was issued and must remain posted for 30 days. Failure to maintain posting will result in a $100 civil penalty. Appeal Rights were provided. An exit interview was conducted, and the report was reviewed with the Licensee, Chunte Melvin.

Lady King
Sara Rajapakse Montolla
DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 10/01/2026 10:47 AM - It Cannot Be Edited


Created By: Sara Rajapakse Montolla On 10/01/2026 at 09:45 AM
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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MELVIN FAMILY CHILD CARE
FACILITY NUMBER: 157700063

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/12/2026
Section Cited
CCR
102423(a)(2)

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Section 102423(a)(2) – Personal Rights
Each child receiving services in a family child care home shall have certain rights ...These rights include, but are not limited to, the right to receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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LIcensee stated that signs with the age range will be posted on or near the play equipment, play equiment currently on concrete will be moved over to grass, and Licensee will meet with staff to go over play equipment ages and safety.
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This requirement is not met as evidenced by the incident on 08/17/2026, when the Licensee’s assistant allowed Child #1 to use equipment that was not age appropriate, resulting in Child #1 sustaining a head contusion.
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Licensee will provide via email to LPA Rajapakse 1) photos showing changes in play equipment location and soft landing, 2) photos of signs in the playground with age rages, and 3) staff metting sign-in sheet.

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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.
Lady King
NAME OF LICENSING PROGRAM MANAGER:
Sara Rajapakse Montolla
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2026


LIC809 (FAS) - (06/04)
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