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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845712
Report Date: 10/01/2024
Date Signed: 10/01/2024 04:42:49 PM

Document Has Been Signed on 10/01/2024 04:42 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:SHEIKH FAMILY CHILD CAREFACILITY NUMBER:
334845712
ADMINISTRATOR/
DIRECTOR:		RUBBIYA SHEIKHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 363-2440
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
10/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Rubbiya Sheikh, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
NARRATIVE
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 9/16/2024. It indicated that on 9/16/2024 a child was left alone during school drop off by the facility staff. Staff left the child in line with other children and their authorized representatives while she moved her vehicle from the drop off zone. On her way back, she was met with school staff and the child where she was reminded she must sign the child in/out every time during drop off/pick-up.

Facility records were reviewed, and staff interviewed. Based on the information gathered, the following violations have been identified. The child was left unsupervised which is a personal rights violation.

See LIC809-D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12.

An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to facility staff.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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 10/01/2024 04:42 PM - It Cannot Be Edited


Created By: Claudia Caywood On 10/01/2024 at 03:58 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SHEIKH FAMILY CHILD CARE
FACILITY NUMBER: 334845712

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2024
Section Cited
CCR
102423(a)(2)

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Personal Rights- 102423(a)(2) Each child receiving services from a family child care... are not limited to, the following: (2)To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This was not met as evidenced by:
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Licensee agreed to provide the department with a written statement stating how they will handle the situation differently and that they understand the Personal Rights section 102423(a)(2) CCR by the POC due date of 10/4/2024
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Based on LPAs interviews and records review, the facility staff left a child unsupervised which posed a potential health, and safety, or personal rights risk to the child 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:Gilbert Sena
LICENSING EVALUATOR NAME:Claudia Caywood
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2024


LIC809 (FAS) - (06/04)
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