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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417325
Report Date: 02/21/2024
Date Signed: 02/21/2024 01:03:01 PM

Document Has Been Signed on 02/21/2024 01:03 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BEBAWI, EVALEN & BEBAWY, KAROLEENFACILITY NUMBER:
274417325
ADMINISTRATOR:BEBAWI,E.&BEBAWY,K.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 884-6139
CITY:MARINASTATE: CAZIP CODE:
93933
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
02/21/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Evalen Bebawi & Karoleen Bebawy TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Elizabeth Larios conducted an unannounced case management during another visit and met with Evalen Bebawi, Licensee. LPA observed four infants, two toddler children, and Licensee's Assistant (daughter), Karoleen Bebawy and son Beshoy Bebawi during today's inspection. LPA observed infant (C1) fell asleep and was place in a napping cot with blankets by Licensee Evalen. LPA advised Licensee that as per Title 22-102425 Infant Safe Sleep regulations, there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard and should be free from loose articles and objects. Licensee immediately removed the blankets from the infant. The infant woke up and Licensee Evalen removed infant from napping cot. Licensee was provide the following forms:

LIC311D Forms/Records to Keep in your Family Child Care Homed the following forms and regulations for guidance during today's inspection:
LIC9227 Individual Infant Sleeping Plan
Title 22 Infant Safe Sleep

Deficiency was cited, appeal rights were given to Licensee, Evalen see (809-D). Exit interview was conducted with Licensee, Evalen & son Beshoy.

A Notice of Site Visit was issued and must be posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2024
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 2
Document Has Been Signed on 02/21/2024 01:03 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 02/21/2024 at 12:14 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BEBAWI, EVALEN & BEBAWY, KAROLEEN
FACILITY NUMBER: 274417325

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/23/2024
Section Cited
CCR
102425(a)(b)

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102425 INFANT SAFE SLEEP
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (b) Cribs or play yards shall be free from all loose articles and objects.


This requirement was not met as evidenced by:
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Licensee immediately removed infant (C1) from cot and removed blankets. Licensee will review Infant Safe Sleep Regulations and submit a statement of understanding regarding ensuring there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard and cribs or play yards shall be free from loose articles at all times.
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Based on observation, Licensee did not comply with the section cited above. LPA observed infant (C1) fell asleep and was place in a napping cot with blankets by Licensee Evalen which posed a potential health, safety or personal rights risk to persons in care.
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Licensee will submit photo of play yards purchase by POC date 2/21/2024.

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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:Joel Segura
LICENSING EVALUATOR NAME:Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024


LIC809 (FAS) - (06/04)
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