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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004103
Report Date: 06/30/2022
Date Signed: 06/30/2022 12:58:29 PM

Document Has Been Signed on 06/30/2022 12:58 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: 6DATE:
06/30/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Najim Sami BelalitTIME COMPLETED:
01:15 PM
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On June 30, 2022 at approximately 11:45am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, follow-up, capacity increase inspection. LPA met with licensee, Najim Sami Belalit, and explained the purpose of the inspection. Present during inspection included licensee and 6 enrolled children (1 infant and 5 preschool age). Licensee is operating within capacity limits at time of LPA's inspection.

The licensee currently rents the home and is currently licensed for a small family child care home. The licensee applied for a large family child care home license on March 4, 2022. The home received fire clearance June 13, 2022.

Hours of operation are Monday to Friday from 8:30am to 5:00pm. The DAY CARE AREAS are the kitchen, living room, dining area, 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 home to be equipped with a variety of age appropriate toys that were in good condition. Outdoor area is equipped with age appropriate toys and materials that were also in good working condition. LPA did not observe any pools, spas or bodies of water on the property. All cleaning supplies, poisons, other chemicals and sharp objects were stored inaccessible to children on high shelves and/or behind child safety locked cabinets.

Home is equipped with a fully charged fire extinguisher, smoke/carbon monoxide detectors and working phone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BELALIT, NAJIM SAMI
FACILITY NUMBER: 384004103
VISIT DATE: 06/30/2022
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Capacity limits and ratios for a large family day care have been reviewed with licensee on this date. LPA reminded licensee that an assistant must be present when operating as a large license. LPA reminded licensee when an assistant is not present, licensee must operate as a small license.

The licensee's CPR and First Aid training is current and will expire 03/2024. The licensee's Mandated reporter training is also current and will expire 03/2024. Licensee was reminded baby walkers, bouncer, jumpers and any other similar items are not to be used for children in care.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and 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.

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

A large license has been recommended for facility effective 06/30/2022.

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

Exit interview conducted and report was reviewed with licensee, Najim Sami Belalit.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC809 (FAS) - (06/04)
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