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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700227
Report Date: 04/09/2024
Date Signed: 04/09/2024 01:09:44 PM

Document Has Been Signed on 04/09/2024 01:09 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:ELDEEB, SAHARFACILITY NUMBER:
015700227
ADMINISTRATOR/
DIRECTOR:		ELDEEB, SAHARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 335-9712
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
04/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Tamana RahimiTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 04/09/2024 at 10:00AM, Licensing Program Analyst (LPA) Jaleesa Jackson conducted an unannounced case management visit. LPA met with Licensee's assistant Tamana Rahimi. Present was Dina Gaffar (A1) an adult without a criminal record clearance, 3 preschool aged children, and 3 infants.

Licensee arrived at the home at 11:30AM. Licensee stated that A1 was originally staying with her father due to her fingerprint clearance is still in process. LPA stated on her last visit on 3/26/24 that the fingerprints still said in process and again on 4/3/24. This is a repeat violation from 3/26/2024 for criminal background check clearance.

On 03/26/2024, LPA conducted a case management visit. The Family Child Care Home (FCCH) was cited 1 Type A citations for Criminal Background Check.

The Licensee and LPA developed a Plan of Correction (POC) with submission due dates of 03/27/2024 and LPA conducted a POC visit.

LPA generated a Letter of Deficiency Citations Cleared and provided a copy to the Licensee.

There was 1 deficiency cited on today's visit. See 809-D for deficiency.

LPA Jackson informed licensee Sahar Eldeeb that this report dated 4/9/2024 document 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.

Continued 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2024
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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Document Has Been Signed on 04/09/2024 01:09 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 04/09/2024 at 10:56 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: 04/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2024
Section Cited
CCR
102370(d)(1)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department
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Dina Gaffar is to immediately leave the home until her background check states she has an eligible criminal record clearance. A new live scan must be submitted.
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This requirement is not met as evidenced by:
Based on observation, the licensee did not comply with the section cited above in 1 unclear adult was present in the home which poses an immediate health, safety or personal rights risk to persons 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:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024


LIC809 (FAS) - (06/04)
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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ELDEEB, SAHAR
FACILITY NUMBER: 015700227
VISIT DATE: 04/09/2024
NARRATIVE
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Also, LPA Jackson informed the licensee to provide a copy of this licensing report dated 4/9/2024 that documents any Type A citation 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Sahar Eldeeb.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC809 (FAS) - (06/04)
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