<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004103
Report Date: 01/24/2024
Date Signed: 01/24/2024 03:11:52 PM

Document Has Been Signed on 01/24/2024 03:11 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BELALIT, NAJIM SAMIFACILITY NUMBER:
384004103
ADMINISTRATOR:BELALIT, NAJIM SAMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 361-2769
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
01/24/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Substitute, Lise LeboeufTIME COMPLETED:
03:20 PM
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 January 24, 2024, at 11:30 AM, Licensing Program Analysts(LPAs) Quimbo and Gil arrived at the home to conduct an unannounced Annual inspection. LPAs met with licensee's substitute(S1). The purpose of the inspection was explained. Licensee was not present during today's inspection. Per S1, licensee is in France with his wife and will return within two weeks. No additional staff or adults were present in the home. S1 has a criminal record clearance on file. Per S1, licensee lives in the home with their spouse. LPAs verified the background check clearance of the adults working or living in the home.

There were 9 children present in the home(1 infant and 8 preschoolers). Hours of operation are Monday to Friday from 8:30am to 5:00pm. S1 provides AM snacks, lunch, and PM snacks, which are all prepared and served by the facility. The DAY CARE AREAS are the kitchen, living room, dining area, bedroom #1 (napping room), bathroom #2, deck area and lower backyard. The OFF-LIMIT AREAS are bedroom #2, bedroom #3, bathroom #1, and entire downstairs area. Off limit areas are made inaccessible to children by child safety locks and/or child safety gate. There are stairs in the backyard that also includes child safety gates.

LPAs and S1 inspected the entire childcare area for Health and Safety hazards. There is one dual smoke/carbon monoxide detector was tested detector in hallway, which was observed to be working. One fully charged fire extinguisher was also available in the home, located in the kitchen. First aid was fully stocked and accessible, located in the kitchen.

LPAs requested S1 to open cabinet under kitchen sink. LPAs observed kitchen cabinet under sink to contain cleaning solutions. LPAs observed kitchen cabinet under sink to not have any child safety lock installed. LPAs advised S1 to install a child safety lock on kitchen cabinet with cleaning solutions. During visit, S1 installed a child safety lock.
Continued on Page 2...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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 5
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: 01/24/2024
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
26
27
28
29
30
31
32
Continued, Page 2
Per S1, there is also no weapons or guns in the home. LPAs did not observe any walkers, bouncers, or similar items in home. LPAs also observed the house is in good repair and free of hazards with a proper temperature and ventilation and lighting. Facility operates as a French immersion program. The play area is clean, padded/carpeted and in good condition. LPAs observed that there are a variety of age-appropriate toys, books, and other learning materials available in the home. Electrical outlets were observed to have coverings.

All posting requirements are met and posted near the childcare entrance. S1 has valid CPR and First Aid card expiring on 04/2024. LPAs reviewed facility records. The facility conducts fire and earthquake drills with children at least once every six months. The most recent one was 9/4/23. Out door area is equipped with age -appropriate toys and materials that were also in good condition. There were no pools, spas, and bodies of water on the property.

LPAs reviewed 7 children's records during the inspection. Licensee and S1 maintains through records for all the children, including vaccination records and Parent Right's forms. LPAs confirmed that each child has proper emergency information with the child's full name, phone number, and contact information of the parent or authorized person who may be called in an emergency.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
Continued on Page 2...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: 01/24/2024
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
26
27
28
29
30
31
32
Continued, Page 3
LPA discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility representative 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the facility representative, S1, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Facility is currently licensed for a large family child care home. During LPAs' visit on this date, S1 was working alone with 9 enrolled children.

Facility was cited one Type A citation for operating over capacity. Facility was also cited two Type B citations for a large family child care home having no assistant present and accessible cleaning solutions.

LPA Quimbo informed facility representative, that this report dated 1/24/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care. Also, LPA Quimbo informed the facility representative to provide a copy of this licensing report dated 1/24/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were provided.

Exit interview conducted and report was reviewed with the facility representative, S1.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/24/2024 03:11 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 01/24/2024 at 02:18 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BELALIT, NAJIM SAMI
FACILITY NUMBER: 384004103

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(b)(3)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in
Section 1597.44 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in operating with 9 children. Licensee is a large license, however, due to no assistant being present with S1, facility must operate within capacity limits as a small family child care home, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/25/2024
Plan of Correction
1
2
3
4
LPA discussed with S1 capacity limits and ratio of a large license operating without an assistant present. LPA advised S1 to have an assitant present when operating with 9 children. LPA advised S1 if S1 is working alone, to stagger children's schedules to remain in compliance of a small family child care home.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Marie Rodriguez
LICENSING EVALUATOR NAME:Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 01/24/2024 03:11 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 01/24/2024 at 02:18 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BELALIT, NAJIM SAMI
FACILITY NUMBER: 384004103

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above. LPAs observed cabinet under sink located in kitchen to have accessible cleaning solutions, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/24/2024
Plan of Correction
1
2
3
4
During visit, S1 installed a child safety lock on cabinet under sink located in kitchen.
Type B
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above. S1 was present with 9 children without an additional helper, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/25/2024
Plan of Correction
1
2
3
4
Per S1, an additional assistant, with fingerprint clearance, will be present at facility as of 1/25/2024. LPA advised for licensee to review original license issued to licensee with capacity comments.
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:Marie Rodriguez
LICENSING EVALUATOR NAME:Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024


LIC809 (FAS) - (06/04)
Page: 5 of 5