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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430754912
Report Date: 06/06/2025
Date Signed: 06/06/2025 03:40:33 PM

Document Has Been Signed on 06/06/2025 03:40 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CHEKENI, MAHJABIN AND AHMADFACILITY NUMBER:
430754912
ADMINISTRATOR/
DIRECTOR:		CHEKENI, MAHJABIN & AHMADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 223-3771
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/06/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Mahjabin & Ahmad ChekeniTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 06/06/2025 at 1:00pm, Regional Manager (RM) Loretta Dyson, Licensing Program Manager (LPM) Chandra Charles, and Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with Licensees Mahjabin “Mali” and Ahmad Chekeni at the Oakland Southeast Regional Office for a Non-Compliance Conference (NCC). The purpose of the NCC is to discuss recent citations and advisory notes issued during the annual inspection on 05/19/2025.

On 05/19/2025, LPA issued two (2) Type B citations, four (4) Advisory Notes – Technical Violations, and one (1) Advisory Notes – Technical Assistance. The citations and advisory notes addressed safety precautions and maintenance of physical plant, Infant Safe Sleep regulations, recordkeeping requirements. LPA observations also raised concerns regarding lack of supervision at the facility.

During the meeting, RM Dyson and LPM Charles reviewed the citations and advisory notes issued by LPA Zhu on 05/19/2025 based on the observations. RM and LPM also discussed with Licensees supervision requirements in a Family Child Care Home (FCCH).

During the 05/19/2025 annual inspection. LPA was informed by Licensee the Fire Inspector recently conducted an inspection and pointed out concerns regarding the exits of the home. On 05/21/2025, LPA made initially contact with the Fire Inspector. Fire Inspector informed he conducted an annual fire inspection in April 2025, and there were a number of violations. On 05/21/2025, Oakland Southeast Regional Office (RO) submitted new fire clearance request to the Palo Alto Fire Department. On 05/23/2025, RO received denied fire clearance for the facility. As a result of the denied fire clearance, which supersedes previous granted fire clearances, Licensees were advised to operate as a small Family Child Care Home in the main house until a fire clearance is granted. Licensee shall comply with the Fire Department until a fire clearance is granted. When RO receives a granted fire clearance, Licensees may still be subjected to limitations in their operation of the Family Child Care Home based on special conditions. Page 1 of 2. See LIC 809C.

Chandra CharlesTELEPHONE: (510) 286-0966
Jialing ZhuTELEPHONE: 510-622-2602
DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2025
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
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 06/06/2025 03:40 PM - It Cannot Be Edited


Created By: Jialing Zhu On 06/06/2025 at 01:11 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEKENI, MAHJABIN AND AHMAD
FACILITY NUMBER: 430754912

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/09/2025
Section Cited

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102417(a) Operations of a Family Child Care Home: The licensee shall be present in the home and shall ensure that children in care are supervised at all times.
This requirement was not met as evidenced by:
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as children were unsupervised in a building where Licensees and/or adults were not present, which poses an immediate health, safety, and/or personal rights risk to persons in care.
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Links to the videos will be provided by LPA via email.

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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.
Chandra Charles
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE: (510) 286-0966
Jialing Zhu
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: 510-622-2602
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CHEKENI, MAHJABIN AND AHMAD
FACILITY NUMBER: 430754912
VISIT DATE: 06/06/2025
NARRATIVE
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One (1) Type A citation was issued during today's meeting:

· On 05/19/2025 during the annual inspection, LPA observed the children in care were not under the supervision of any adult in the detached cottage. Both Licensees were observed to be situated in the main house. Licensee stated she had only stepped out of the cottage and into the main house for a short period of time upon LPA's arrival.

As a result of today’s NCC and Type A citation issued, a copy of this LIC 809 report and LIC 9224 Acknowledgment of Receipt of Licensing Reports must be provided to parents/guardians of currently enrolled children in care and all children to be enrolled following a 12-month period of this report. The LIC 9224 must be signed within the next business day the children are in care and is to be kept in the children’s files.

Exit interview was conducted, report was reviewed, and Appeal Rights were provided to Licensees Mali and Ahmad Chekeni.

Page 2 of 2. End of Report.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Jialing ZhuTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

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

DATE: 06/06/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4