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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004103
Report Date: 02/23/2022
Date Signed: 02/23/2022 03:29:01 PM

Document Has Been Signed on 02/23/2022 03:29 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BELALIT, NAJIM SAMIFACILITY NUMBER:
384004103
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
02/23/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Najim Sami BelalitTIME COMPLETED:
03:35 PM
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On February 23, 2022 at 2:30pm, Licensing Program Analyst (LPA) Catrina Quimb conducted an unannounced, case management inspection. LPA met with licensee, Najim Sami Belalit and explained the purpose of the inspection. Present in the home were licensee, licensee's mother, and 4 enrolled children (1 infant and 3 preschool age). All adults living and/or working in the home have a criminal record clearance on file. LPA observed licensee's Pediatric First Aid/CPR certificate to be valid and will expire 10/2023.

Licensee is currently licensed for a small family child care home. Licensee requested to add the backyard (off limit area) as part of the day care area. LPA and licensee inspected the outdoor area for health and safety hazards. Hours of operation are Monday to Friday from 8:30am to 5:00pm.

Licensee rents the home which is a multi-level, single family home that consists of kitchen, 3 bedrooms, 2 and a half bathrooms, living room, dining room, play room, deck area, backyard and garage. The DAY CARE AREAS now approved are the kitchen, living room, dining room, play room, bedroom #1 (napping room), bathroom #2, deck area and lower backyard. The OFF LIMIT AREAS are bedroom #2, bedroom #3, bathroom #1, hallway and entire downstairs area. All off limit areas are made inaccessible to children by child safety locks.

LPA observed outdoor area to have age appropriate equipment that were in good working condition. Access to lower backyard includes stairs that are barricaded with child-safety gates. Backyard does not have any pools, spas or bodies of water. Entire backyard is enclosed with a fence at least 4ft high. Licensee has removed rose bushes in backyard and has replaced flooring with wood chips.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BELALIT, NAJIM SAMI
FACILITY NUMBER: 384004103
VISIT DATE: 02/23/2022
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Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.

Licensee was reminded that all adults 18 and older living or working in the home, including employees, volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

After today's inspection, no deficiencies were cited today.

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

An exit interview was conducted and report was reviewed with the licensee, Najim Sami Belalit.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC809 (FAS) - (06/04)
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