384004103-4-3-2026-05-CC-CQUO-DSSNBK-20260403101916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004103
Report Date: 04/03/2026
Date Signed: 04/03/2026 10:19:23 AM

Document Has Been Signed on 04/03/2026 10:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	BELALIT, NAJIM SAMI		FACILITY NUMBER:	384004103
ADMINISTRATOR/ DIRECTOR:	BELALIT, NAJIM SAMI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 805-8165
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 8	DATE:	04/03/2026
TYPE OF VISIT:	POC	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Najim Sami Belalit		TIME VISIT/ INSPECTION COMPLETED:	10:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On April 3, 2026 at approximately 8:45am, Licensing Program Analyst (LPA) Quimbo conducted an unannounced, plan of correction (POC) visit to the home. LPA met with assistant, Marc Peron, and explained the purpose of the visit. LPA was granted entry into the home. Upon LPA's arrival, licensee was not present. 8 preschool children were present with two assistants. Staff present have fingerprint clearance on file. At approximately 9:10am, licensee, Najim Sami Belalit, arrived to facility. LPA continued visit with licensee. On February 5, 2026, LPA conducted an unannounced, case management visit to the home. Licensee previously informed LPA that facility was closed and not in operation through February 12, 2026. LPA issued one Type A deficiency for licensee's temporary absence exceeding 20 percent of operating hours a day. A POC was discussed with assistant present during visit. LPA was informed licensee was to return to the home end of February 2026. After case management visit conducted on February 5, 2026, licensee informed LPA licensee is not present due to personal reasons. Per licensee, program operates primarily outdoors as an "outdoor day school" with pick up and drop off occurring at the home. On March 17, 2026, LPA conducted an unannounced, POC visit. Licensee was not present during visit. LPA reviewed completed Acknowledgement of Receipt of Licensing Reports (LIC9224s) for all enrolled children for the Type A deficiency issued on February 5, 2026. LPA issued a second Type A deficiency for licensee's temporary absence exceeding 20 percent of operating hours a day on March 17, 2026. A POC was discussed with assistant present during visit. LPA was informed licensee was to return to the home March 28, 2026. Proof of return was provided to LPA during visit. (Continue report on page 2...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BELALIT, NAJIM SAMI	FACILITY NUMBER: 384004103
	VISIT DATE: 04/03/2026

NARRATIVE

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(Continued, Page 2...)
During today's visit, LPA reviewed Acknowledgement of Receipt Licensing Reports (LIC9224s) for enrolled children for the Type A deficiency issued on March 17, 2026. LPA observed Notice of Site visit to also be posted in the home, available for review.

On March 30, 2026, licensee submitted documentation to the San Bruno Regional Office in regards to adding a co-licensee to the home. Licensee was informed the addition of a co-licensee requires management approval.

LPA and licensee discussed regulation of licensee being present in the home during operating hours. LPA reminded licensee regulations will apply to both co-licensees (if co-licensee is added). Licensee stated they are aware that licensee's temporary absence cannot exceed 20 percent of operating hours a day.

Licensee stated they will consider permanent closure of home. Per licensee, another individual may submit a new family childcare home application.

No deficiencies were issued during today's visit.

LPA cleared deficiencies issued from February 5, 2026 and March 17, 2026. POC letters were provided to licensee.

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

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

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC809 (FAS) - (06/04)

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