384004103-3-27-2025-05-CC-CQUO-DF6PFA-20250327111625

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004103
Report Date: 03/27/2025
Date Signed: 03/27/2025 11:16:32 AM

Document Has Been Signed on 03/27/2025 11:16 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:	03/27/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:35 AM
MET WITH:	W1 & Najim "Sam" Belalit		TIME VISIT/ INSPECTION COMPLETED:	11:30 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 March 27, 2025 at approximately 8:35am, Licensing Program Analyst (LPA) Quimbo conducted an unannounced, annual inspection. Upon LPA's arrival, licensee was not present. LPA met with licensee's assistant, A1, and licensee's wife, W1. LPA explained the purpose of the visit to A1 and W1. LPA was granted entry into home. Per A1 and W1, licensee had a pre-scheduled appointment. At start of LPA's visit, children were arriving to facility. Per W1, licensee and W1 are the only adults living in the home. All adults present during today's visit and living in the home have fingerprint clearance on file. Hours of operation are Monday through Friday 8:30am to 5:00pm. With W1, LPA inspected day care areas for health and safety hazards. Home is a multi-level home with a ground level and second level. The DAY CARE AREAS are the kitchen, living room (main day care area), dining area, bedroom #1 (napping room by front entrance), hallway bathroom (bathroom #2), deck area and lower backyard. The OFF LIMIT AREAS are bedroom #2, bedroom #3, bathroom #1 (connected to bedroom #2), and entire ground floor (except backyard). Off limit areas are made inaccessible to children with a child safety gate. There are stairs inside the home that are made inaccessible with a locked door. There are also stairs in the backyard that include a child safety gate at the top of the stairs and the bottom of the stairs. At approximately 9:30am, 8 children (2 infants and 6 preschool age) were present during LPA's visit. Home is operated as a French immersion program. Home is operating within capacity limits and ratio during today's visit. LPA observed day care areas to be clean, free of defects. There is a fireplace in the living room that is made inaccessible to children. LPA observed an appropriate amount of materials and toys for children that are in good condition. Furniture for children's use are also age appropriate and in good condition. LPA observed a rug in the day care area that is clean and free of stains. LPA observed electrical outlets to be made inaccessible with child safety covers. (Continue Report on Page 2...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

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: 03/27/2025

NARRATIVE

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LPA did not observe any accessible cleaning solutions or poisons in day care areas. In kitchen, LPA observed knives and sharp objects to be stored on a high shelf, inaccessible to children. LPA did not observe accessible poisons or chemicals in drawers or shelves in kitchen.

At approximately 9:45am, Licensee, Najim "Sam" Belalit arrived to facility, LPA continued annual inspection with licensee. Food service is provided that includes morning snack, lunch and afternoon snack. Licensee stated vegetarian food service is provided for enrolled children. Reusable dishes are utilized for children that are sanitized in home's dishwasher. Per licensee, children are able to bring their own food to facility, if needed. LPA observed children's individual food containers to be labeled with their names.

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/.

Bathroom for children's use was observed to be in working condition and equipped with age appropriate toileting equipment. Diapers are made available for children, if needed. LPA observed home is equipped with a garbage bin with a tight fitting lid.

Children sleep in the napping room. Floor mats are utilized for all napping children. Sleeping bags, sheets and blankets are provided by children's families. Per licensee, floor mats are sanitized every two days; sheets and blankets are sent home to be laundered every two days. Licensee maintains a sleeping log for napping infants. LPA observed sleeping log includes the date the infant is sleeping, the infant's sleeping position, body temperature, the initials of the staff checking on the infant and any comments. LPA reminded licensee sleeping log must document the 15 minute time stamp of when the infant is checked on while sleeping. Technical violation was issued.

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-andresources/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.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

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

FACILITY NAME: BELALIT, NAJIM SAMI	FACILITY NUMBER: 384004103
	VISIT DATE: 03/27/2025

NARRATIVE

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LPA observed a fully charged fire extinguisher, fully stocked first aid kit and smoke and carbon monoxide detectors throughout the home. LPA tested carbon monoxide detector in home, which was observed to be working during LPA's visit.

Licensing documentation is properly posted and made available for review. A childcare roster was also made available for LPA's review. Emergency disaster drills are conducted monthly and are appropriately documented. Last disaster drill was conducted 3/12/2025. Per licensee, there are no weapons or firearms in the home.

LPA reviewed facility records that included six random children's records and facility staffs' records. Children's records are complete. LPA reviewed licensee, W1, and A1's files that are also complete with immunization records. All staff present have a current CPR/First Aid certification. Licensee's Mandated Reporter certification is also current and made available for review.

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.

Licensee 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.

Licensee 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 licensee, Najim Sami Belalit, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were issued today during LPA's visit. 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.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

LIC809 (FAS) - (06/04)

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