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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700227
Report Date: 04/06/2022
Date Signed: 04/06/2022 12:27:52 PM

Document Has Been Signed on 04/06/2022 12:27 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:ELDEEB, SAHARFACILITY NUMBER:
015700227
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
04/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Sahar EldeebTIME COMPLETED:
12:40 PM
NARRATIVE
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On 04/06/2022 approximately at 10:10AM, Licensing Program Analyst (LPA) Kelly Phan met with Licensee Sahar Eldeeb and her fingerprinted and associated staff member for the purpose conducting a case management inspection to verify if corrections were made. Present for this inspection was two infants and six preschool aged children. Licensee states she has two of her own foster children present today. LPA entered the facility and began the inspection of the facility to conduct a health and safety check.

At 10:20AM, LPA toured the outdoor area and observed that the paved concrete area was corrected after discussing with a staff member during their annual visit on 02/15/2022. Licensee has required documents posted visible in her facility including a fire and disaster drill last conducted on 2/22/2022. LPA went ahead and inspect the on-limit areas: living room, dining room, bathroom #1, patio, fenced area of the backyard, and kitchen, which are neat and clean. LPA observed that there were still toys present in the sleeping cribs; LPA suggests to licensee that a fitted sheet is the only thing allowed inside a sleeping crib. Licensee states that the children does not sleep in the play pen, only plays inside and have designated cribs/pens for sleeping. LPA also had asked licensee to remove objects from the playpen

At 10:40AM, LPA went ahead and review documentation (LIC 282 and sleep logs) for children along with staff member's file. LPA suggests to licensee that the sleep logs should have appropriate dates and times. LPA also observed an immunization summary mixed with sleep logs, which belongs to a child who had missing immunizations; licensee states that the mother states the child shall receive the rest of the vaccines once she reaches 5 months old. LPA also reviewed her staff files and found it to be incomplete as it is still missing her immunization records. Staff member states that she has an appointment scheduled to obtain her medical record.

SEE LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: ELDEEB, SAHAR
FACILITY NUMBER: 015700227
VISIT DATE: 04/06/2022
NARRATIVE
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There were Three (3) deficiencies were cited for today's inspection
Type B: at 10:40AM, LPA also reviewed her staff files and found it to be incomplete as it is still missing her immunization records. Staff member states that she has an appointment scheduled to obtain her medical statement. Type B deficiency was cited. See LIC 809D

Type B: also at 10:40AM, LPA also observed an immunization summary mixed with sleep logs, which belongs to a child who had missing immunizations during last annual visit on 02/25/2022; licensee states that the mother states the child shall receive the rest of the vaccines once she reaches 5 months old. LPA also verified with staff member who states the child is about 3 to 4 months old right now. SEE LIC 809D.

Type A: At 11:20AM, LPA verified with licensee that one of the child is five years old and half and supposed to be attending transitional kindergarten (TK), but she missed the age and were not enough space in TK program, and her mother wanted to place her at her day care. LPA informed licensee that her license only allows for 4 infants; six children who are no more than three of whom may be infants; and if more than six children, the two additional children shall be enrolled and attending kindergarten or elementary school and at least six years old. Type A deficiency is cited. See LIC 809D.

LPA Kelly PHAN informed licensee Sahar that this report dated 04/06/2022 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Kelly PHAN informed the licensee to provide a copy of this licensing report dated 04/06/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with licensee Sahar Eldeeb.



SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
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Document Has Been Signed on 04/06/2022 12:27 PM - It Cannot Be Edited


Created By: Kelly Phan On 04/06/2022 at 11:39 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ELDEEB, SAHAR
FACILITY NUMBER: 015700227

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/06/2022
Section Cited
CCR
102416.5(b)(3)

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102416.5 (b)(3) For a Small Family Child Care Home, the maximum number of children for whom care may be provided including children under age 10 who reside at the licensee's home...More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met.
This requirement is not met as evidenced by:

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Based on observation and interview with licensee, licensee did not comply with the section stated as LPA observed 8 children present today, and verified with licensee that the child is not attending school and is not at least six years old, which poses an immediate health, safety, or personal right risk to children in care.
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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.
SUPERVISOR'S NAME:Jason Jang
LICENSING EVALUATOR NAME:Kelly Phan
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022


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Document Has Been Signed on 04/06/2022 12:27 PM - It Cannot Be Edited


Created By: Kelly Phan On 04/06/2022 at 11:51 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ELDEEB, SAHAR
FACILITY NUMBER: 015700227

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/06/2022
Section Cited
CCR
102418(g)

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Immunization 102418(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
This requirement was not met as evidenced by:
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Based on observation, interview, and record review, licensee did not comply with the section stated as LPA verified and reviewed documentation with licensee that she does not have other immunization records for the child as her mother would bring the child to receive the rest of her vaccines once she reaches 5 months old, which poses a potential health, safety, or personal risks to children in care.
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Type B
04/06/2022
Section Cited
CCR102416(1)(a)

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Personal Requirements 102416(1)(a): Health and Safety Code Section 1596.866 provides in part...The training shall include pediatric cardiopulmonary resuscitation, pediatric first aid, recognition, management, and prevention of infectious diseases, including immunizations
This requirement is not met as evidenced by:
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Based on observation, interview, and record review, licensee did not comply with the section as LPA verified with staff member and review staff file that immunizations were still missing, which poses a potential health, safety, or personal right risks to children in care.
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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.
SUPERVISOR'S NAME:Jason Jang
LICENSING EVALUATOR NAME:Kelly Phan
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022


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