<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406222
Report Date: 12/20/2019
Date Signed: 12/20/2019 03:37:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BEKHIT, SAMIAFACILITY NUMBER:
073406222
ADMINISTRATOR:BEKHIT, SAMIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 888-3834
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:14CENSUS: 9DATE:
12/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Samia BekhitTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced ANNUAL/RANDOM inspection. Present during today’s inspection was the licensee, her finger print cleared husband, 17 year old granddaughter, Sandra Aziz, three infants and six preschool aged children in care.

The home was toured for Health and Safety Inspection. On limits area consist of the family room, first floor bedroom, first floor bathroom, kitchen, backyard and the garage (which as been converted into a play room). Children do not eat or sleep in the garage as stated by the licensee. Fire clearance dated 5/20/08 does not indicate that the garage is off limits. Off limits area consists of the living room, dining room , and the entire second floor. There are no pools, spas, hot tubs, or any other similar bodies of water at this home. There are no firearms on the premises as stated by the licensee. The home has a gas fireplace, which is made inaccessible by glass. The fireplace is not used during child care hours as stated by the licensee. Gates are used to make the off limits area inaccessible to children. The stairs are located in the off limits area of the home. LPA verified that the fire extinguisher 3A40BC is fully charged. The home is equipped with both a smoke detector and carbon monoxide detector. There is a working telephone in the home. The home provides toys and play equipment. Outdoor play area is fenced.

The licensee is operating within the licensed capacity.

Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children or an immediate civil penalty can be assessed.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BEKHIT, SAMIA
FACILITY NUMBER: 073406222
VISIT DATE: 12/20/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Children files were reviewed.

Fire and disaster drills are conducted monthly.

The licensee was encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

During the inspection the following deficiencies were observed:

- at approximately 12:30pm LPA observed children napping in the bedroom on the second level of the home which is off limits to children.

- at approximately 1:00pm during file review, LPA observed of the 9 file reviewed three children need not have the Consent for Medical Treatment form completed for C1, C2, and C8.

- at approximately 1:30pm LPA observed cleaning supplies in the unlocked cabinet in the on limits bathroom accessible to children. LPA also observed cleaning supplies in an unlocked cabinet in the kitchen accessible to children.

Exit interview was conducted Samia Bekhit.
Licensee was provided a copy of the appeal rights.
Notice of Site visit was provided at the time of inspection and must be posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 2 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: BEKHIT, SAMIA
FACILITY NUMBER: 073406222
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2020
Section Cited

1
2
3
4
5
6
7
Alterations to Existing Buildings or Grounds. Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:
8
9
10
11
12
13
14
Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. This requirement was not met as evidenced by: During LPA's inpsection children were napping on in the off limits bedrooms located on the second floor, which is a potential risk to the heralth and safety of children in care.
8
9
10
11
12
13
14
• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type B
01/03/2020
Section Cited

1
2
3
4
5
6
7
An Operation of a Family Child Care Home emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible
8
9
10
11
12
13
14
adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requiremnet was not met as evidenced by: 3 children did not have, form LIC627, Consent for Emergency Medical Treatment completed, which poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 4 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: BEKHIT, SAMIA
FACILITY NUMBER: 073406222
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2020
Section Cited

1
2
3
4
5
6
7
Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Poisons, detergents, cleaning compounds, medicines, firearms and other
8
9
10
11
12
13
14
items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.This requirement was not met as evidenced by: LPA observed cleaning supplies accessible to children during the inspection.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4