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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700227
Report Date: 09/23/2024
Date Signed: 09/23/2024 06:24:06 PM

Document Has Been Signed on 09/23/2024 06:24 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: 10DATE:
09/23/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:53 PM
MET WITH:Sahar EldeebTIME VISIT/
INSPECTION COMPLETED:
06:21 PM
NARRATIVE
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On 9/23/2024 at 1:53pm Licensing Program Analyst (LPA) Morgan Pringle conducted an Unannounced Plan of Correction Visit to verify that corrections had been made from LPAs previous visit on 9/13/2024. Present during the inspection upon LPAs arrival were three (3) infants, five (5) preschoolers, two (2) school age children and three (3) additional adult helpers. Licensee's home was toured for a health and safety inspection. Facility operates 24hours, Monday - Friday.

Licensee holds a license for foster care of 5 children and currently has five (5) foster children living in her home, ages 4, 3, 3, 1 and 5 months old. License number, 075200120.

LPA conducted a case management visit on 9/13/2024 and Licensee was cited 1 Type A Deficiency and 5 Type B Deficiencies.

Deficiencies cited during LPAs visit on 9/13/2024:
· Type B - Eight children's files missing LIC282
· Type B - Five children's files missing immunization records
· Type B - Five children's files missing LIC700 Identification and Emergency Information form
· Type B - Nine children's files missing LIC9150
· Type B - LIC9224 missing from all children files for previous type A deficiencies cited within 12 months
· Type A - Infant sleeping in crib without a tight fitted sheet (Repeat Violation)

As of today, 9/23/2024 Licensee has corrected the 1 Type A deficiency and 4 of the Type B deficiencies. LPA conducted file reviews of the children's files and staff files. Through record review it was found that all three staff present were missing Mandated Reporter training certificates, EMSA approved CPR & First Aid certificates, immunization record for Tdap, MMr, and Influenza. All three staff present were also missing LIC9052 Employee Rights and one (1) infant present was missing LIC9227 Individual Infant Sleeping Plan.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
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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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: 09/23/2024
NARRATIVE
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Licensee was previously sited for three (3) type A deficiencies on 3/11/2024, one (1) type A deficiency on 3/26/2024, one (1) type A deficiency on 4/9/2024 and four (4) type A deficiencies on 9/13/2024. Licensee was informed that LIC9224 Acknowledgement of Receipt of Licensing Report was to be given to all parent(s)/authorized representative(s), along with the reports from that day, and the form was to be placed in the children’s file. Through record review seven (7) children were missing LIC9224 for the 3/11/2024, 3/26/24 and 4/9/2024 inspections and six (6) children were missing LIC9224 for the 9/13/2024 inspection.

Type B deficiencies cited during todays visit, 9/23/2024
  • All 3 Staff missing Mandated Reporter training certificates
  • Staff missing EMSA approved CPR & First Aid training
  • All 3 staff missing Immunization record for Tdap and Mmr
  • All 3 staff missing LIC9052
  • 1 infant present missing LIC9227
  • 13 children missing LIC9224 from their files for previous Type A deficiencies cited

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

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

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 09/23/2024 06:24 PM - It Cannot Be Edited


Created By: Morgan Pringle On 09/23/2024 at 04:48 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: 09/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2024
Section Cited
CCR
102416(a)(1)

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102416(a) The licensee shall provide each employee with a copy of the Notice of Employee Rights (LIC 9052...(1) Each employee shall be requested to sign and date the notice form acknowledging receipt. This requirement was not met as evidenced by:
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Licensee will ensure that all staff have a signed and dated copy of LIC9052 in their file.
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Through record review it was found that all 3 staff present did not have LIC9052 in their file which presents a potential risk to the health, safety and personal right of the children in care.
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Type B
10/04/2024
Section Cited
CCR102416(c)

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102416(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement was not met as evidenced by:
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Licensee has stated that the staff is registered for a EMSA approved CPR & First Aid training course on Friday, 10/4/2024. Licensee will send LPA Pringle copies of certificates upon receipt.
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Through record review it was found that staff present do not have current EMSA approved CPR & First Aid which presents a potential risk to the health, safety and personal right 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: 09/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 09/23/2024 06:24 PM - It Cannot Be Edited


Created By: Morgan Pringle On 09/23/2024 at 05:02 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: 09/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2024
Section Cited
HSC
1596.8662(b)(1)

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1596.8662(b)(1)...employee of a licensed child day care facility shall complete the mandated reporter training...and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial...training.
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Licensee will ensure that all staff complete the Mandated Reporter training by Friday, 9/27/2024. Licensee will send LPA Pringle certificates as proof of correction.
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This requirement was not met as evidenced by: All 3 staff present were missing Mandated Reporter training certificates which presents a potential risk to the health, safety and personal right of the children in care.
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Type B
09/27/2024
Section Cited
HSC1597.622(a)(1)

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1597.622(a)(1)...a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles...
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Licensee will obtain immunization records from all staff and send copy to LPA Pringle. if records cannot be obtained staff will need to make an appointment will physician to obtain record of immunity. Licensee will inform LPA of date of appointment.
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This requirement was not met as evidenced by: Through record review all staff present were missing immunization records which presents a potential risk to the health, safety and personal right 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: 09/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 09/23/2024 06:24 PM - It Cannot Be Edited


Created By: Morgan Pringle On 09/23/2024 at 05:23 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: 09/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2024
Section Cited
HSC
1596.8595(c)(1)

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1596.8595A 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 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 13 children are missing LIC9224 Acknowledgement of Receipt of Licensing Report which presents a potential risk to the health, safety and personal right of the children in care.
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Type B
09/27/2024
Section Cited
CCR102525(c)

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102425(c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file. This requirement was not met as evidenced by:
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Licensee will obtain completed LIC9227 from infants parent and send a copy to LPA Pringle as proof of correction. Form will be placed in child file.
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Through record review it was found that 1 infant in care is missing LIC9227 from their file which presents a potential risk to the health, safety and personal right 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: 09/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024


LIC809 (FAS) - (06/04)
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