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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700227
Report Date: 09/13/2024
Date Signed: 09/13/2024 06:21:59 PM

Document Has Been Signed on 09/13/2024 06:21 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/
DIRECTOR:		ELDEEB, SAHARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 335-9712
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 11DATE:
09/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Sahar EldeebTIME VISIT/
INSPECTION COMPLETED:
06:19 PM
NARRATIVE
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On 9/13/2024 at 9:40am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Sahar Eldeeb for an unannounced case management inspection for an incident that occurred at the facility on 9/11/2024. Present during LPA’s visit were the Licensee, her two (2) adult helpers, three (3) infants and four (4) preschool age children. Four (4) school age children arrived during LPAs visit as well. Licensee’s adult son was present in the home in an off-limit area as well. Licensees home was toured for a health and safety inspection. Licensee stated her new hours of operation are 24hours, Monday - Friday.

During LPAs visit additional violations were found.

10:30am LPA observed an infant in a crib without a tight fitted sheet. The mattress had a blanket over the middle with the sides tucked under the mattress. This observation was also made my LPA Jackson at a previous inspection on 3/11/2024 and was cited a type A deficiency.

11:00am LPA conducted a file review of all the children’s files and found:
· Five (5) children were missing files
· Five (5) files were missing immunization records
· Eight (8) files were missing LIC282 Affidavit Regarding Liability Insurance
· Licensee was previously sited for three (3) type A deficiencies on 3/11/2024, one (1) type A deficiency on
3/26/2024 and one (1) type A deficiency on 4/9/2024. Licensee was informed that LIC9224
Acknowledgement of Receipt of Licensing Report was to be given to all parent(s)/authorized
representative(s) and the form was to be placed in the children’s file. Through record review, none of the
children’s files contained the form and none of the parents were provided licensing reports.
· Nine (9) files were missing LIC9150 Parent Notification Additional Children in Care
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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: 09/13/2024
NARRATIVE
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Deficiencies cited during LPA visit
· Eight children's files missing LIC282
· Five children's files missing immunization records
· Five children's files missing LIC700 Identification and Emergency Information form
· Nine children's files missing LIC9150
· LIC9224 missing from all children files for previous type A deficiencies cited within 12 months
· Infant sleeping in crib without a tight fitted sheet (Repeat Violation)

LPA Pringle informed Licensee that this report dated 9/13/2024 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Pringle informed the Licensee to provide a copy of this licensing report dated 9/13/2024 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.

A civil penalty of $250.00 is also being assessed for a repeat violation of a Type A deficiency.

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.

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

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/13/2024 06:21 PM - It Cannot Be Edited


Created By: Morgan Pringle On 09/13/2024 at 03:59 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: ELDEEB, SAHAR
FACILITY NUMBER: 015700227

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/16/2024
Section Cited
CCR
102425(a)(3)

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102423(a) There shall be one crib or play yard for each infant...(3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.
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Licensee will ensure that the crib has a tight fitted sheet on the mattress while in use by the infant. Licensee will also remove the blanket that is currently being used. Licensee will send LPA proof of correction by POC date.
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This requirement was not met as evidenced by: one infant was observed sleeping on a mattress without a tight fitted sheet, which poses an immediate health to the health and safety or personal rights risk to the 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:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/13/2024 06:21 PM - It Cannot Be Edited


Created By: Morgan Pringle On 09/13/2024 at 04:06 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: ELDEEB, SAHAR
FACILITY NUMBER: 015700227

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
CCR
102421(d)(1)

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102421(d) In any case in which the licensee cares for an additional child ...for a Large Family Child Care Home, the licensee shall maintain, in the child's record, proof of parent notification...(1) The licensee shall maintain a completed and signed LIC 9150 ...
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Licensee will obtain the missing nine (9) LIC9150 forms from the children's authorized representatives. Licensee will send LPA Pringle proof of correction by POC date listed, 9/18/2024.
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This requirement was not evidenced by: 9 childrens files were missing LIC9150 which poses a potential risk to the health and safety of the children in care.
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Type B
09/18/2024
Section Cited
CCR102417(g)(7)

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102417(g)(7) An 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 adult to be contacted in an emergency...This requirement was not met as evidenced by:
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Licensee will obtain the missing five (5) LIC700 forms from the children's authorized representatives. Licensee will send LPA Pringle proof of correction by POC date listed, 9/18/2024.
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Five (5) children enrolled in care are missing LIC700 Identification and Emergency Information form which poses a potential risk to the health and safety of the 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:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/13/2024 06:21 PM - It Cannot Be Edited


Created By: Morgan Pringle On 09/13/2024 at 04:21 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: ELDEEB, SAHAR
FACILITY NUMBER: 015700227

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
CCR
102418(g)

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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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Licensee will obtain the missing required immunization records from the children's authorized representatives. Licensee will send LPA Pringle proof of correction by POC date listed, 9/18/2024.
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Five children enrolled in care are missing an immunization record. This poses a potential risk to the health and safety of the children in care.
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Type B
09/18/2024
Section Cited
CCR102417(m)(3)

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102417(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance...This requirement was not met as evidenced by:
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Licensee will obtain the missing eight (8) LIC282 forms from the children's authorized representatives. Licensee will send LPA Pringle proof of correction by POC date listed, 9/18/2024.
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Eight children enrolled in care are missing LIC282 Affidavit Regarding Liability Insurance. This poses a potential risk to the health and safety of the 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:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/13/2024 06:21 PM - It Cannot Be Edited


Created By: Morgan Pringle On 09/13/2024 at 04:35 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: ELDEEB, SAHAR
FACILITY NUMBER: 015700227

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
CCR
1596.8595(c)(1)

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1596.8595(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child...copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care...
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Licensee will obtain LIC9224 Acknowledgement of Receipt of Licensing Report, from every parent/Guardial enrolled and submit copy to LPA Pringle by POC date.
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This requirement was not met as evidenced by: through record review it was found that all children are missing LIC9224 Acknowledgement of Receipt of Licensing Report and were not provided previous reports. This poses a potential risk to the health and safety to the 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:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024


LIC809 (FAS) - (06/04)
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