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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406222
Report Date: 04/26/2023
Date Signed: 04/26/2023 05:40:45 PM


Document Has Been Signed on 04/26/2023 05:40 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, 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:
04/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Samia BekhitTIME COMPLETED:
05:50 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Case Management visit. Present during the visit was the licensee, her fingerprint cleared husband/assistant, 4 infants and 5 preschool aged children in care. The purpose of today's visit was to provide technical assistance to the licensee. LPA reviewed required documents and regulations with licensee.
LPA also discussed the use of the garage for child care. Licensee is aware that fire clearance for the garage is required before the garage can be made on limits to children. Licensee agrees not to use the garage for child care. Licensee updated the facility sketch during today's inspection. New facility sketch now indicates the on limits of the home as the family room, kitchen, bathroom and bedroom all of which are located on the first floor. The off limits area of the home is the entire second floor, living room, dining room, laundry room and garage.


Notice of Site Visit was provided and must be posted for 30 days.

Report was reviewed with Samia Bakhit
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023
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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