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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004103
Report Date: 05/09/2024
Date Signed: 05/09/2024 02:46:12 PM

Document Has Been Signed on 05/09/2024 02:46 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/
DIRECTOR:		BELALIT, NAJIM SAMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 805-8165
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
05/09/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Najim "Sam" BelalitTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On May 9, 2024 at 2:00pm, Licensing Program Analyst (LPA) Catrina Quimbo and Licensing Program Manager (LPM) Marie Rodriguez, met with licensee, Najim "Sam" Belalit, for an informal office meeting.

On January 21, 2024 LPA conducted an unannounced, annual inspection with licensee's substitute (A1). Licensee was not present and was travelling. During annual inspection, LPA issued one Type A citation for operating over capacity. LPA also issued two Type B citations for accessible cleaning solutions and for A1 operating a large capacity with no assistant present.

On February 2, 2024, LPA conducted a plan of correction (POC) visit. LPA met with A1. Licensee was not present and was travelling. LPA issued one Type B citation for licensee's temporary absence exceeding 20% of operating hours that the facility is providing care per day.

During meeting, following was discussed:
  • Citations issued during annual inspection and POC visit.

Licensee was reminded of following:
  • Licensee is the main provider for the licensed family child care home.
  • If licensee will be temporarily away from facility, licensee must inform department and currently enrolled children's families, prior to temporary absence.
  • If licensee's temporary absence will exceed 20% of operating hours a day, department must be made aware and approve.
  • Licensee's substitute cannot be another licensed provider.
  • If licensee (or substitute) is working alone in licensee's home, licensee (or substitute) must operate within capacity limits of a small licensed family child care home.
  • Licensee's home can only operate as a large capacity when an assistant is present.
  • Licensee must be aware of departments regulations.

Licensee stated they are aware of the importance of complying with all licensing regulations.

Deficiency issued during POC visit was cleared with today's office meeting. Copy of clearance letter provided to licensee during meeting.

Exit interview conducted and report was reviewed with licensee, Najim "Sam" Belalit.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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