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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004103
Report Date: 02/01/2024
Date Signed: 02/01/2024 11:47:51 AM

Document Has Been Signed on 02/01/2024 11:47 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 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:
02/01/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Substitute, Lise LeboeufTIME COMPLETED:
12:00 PM
NARRATIVE
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On February 1, 2024 at approximately 11:00am, Licensing Program Analysts (LPAs) Catrina Quimbo and Janet Gil, conducted an unannounced plan of correction (POC) visit with a case management visit to facility. LPAs met with licensee’s substitute (S1) and explained the purpose of the visit. Licensee was not present during visit. Present during visit included S1, additional assistant (A1), and 9 preschool children.

On January 24, 2024 at approximately 11:30am, LPAs met with S1 to conduct an unannounced, annual inspection at facility. During annual inspection, licensee, Najim Sami Belalit, was not present. During annual inspection, S1 was operating alone with 9 children. Facility was issued a Type A citation for operating over licensed capacity limits. A POC was discussed with S1.

As of this date, LPAs observed S1 to be operating with 9 children and A1. During today’s visit, LPAs observed signed and completed Acknowledgement of Receipt of Licensing Reports (LIC9224) for enrolled children. LPA observed Notice of Site Visit given on 01/24/2024 to be properly posted and as well as deficiency issued. LPAs confirmed facility is operating within licensed capacity limits and ratio on this date.

Deficiency cited on 01/24/2024 has been cleared. LPA provided facility representative copy of POC letter.

During today’s visit and annual inspection conducted on 01/24/2024, licensee, Najim Sami Belalit, was not present in the home. Per S1, licensee is in France. Licensee also emailed LPA on 01/28/2024, confirming they are in France. Prior to licensee travelling, licensee did not inform department of licensee’s absence or of when licensee was to return to home.
(Continue Report on Page 2...)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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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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: 02/01/2024
NARRATIVE
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(Continued, Page 2...)
During today’s visit, facility is issued a Type B citation for licensee not being present 80 percent of operating hours a day, when childcare is provided in the home.

A notice of site visit was given and must remained posted for 30 days. Appeal rights were provided during visit.

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

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/01/2024 11:47 AM - It Cannot Be Edited


Created By: Catrina Quimbo On 02/01/2024 at 11:25 AM
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: 02/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2024
Section Cited
CCR
102417(a)

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102417 Operation of Family Child Care Home (a) The licensee shall be present in the home…temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement was not met as evidenced by:
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An office meeting with licensee to be conducted at a later date.
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Based on observation, interview and record review, the licensee was not present on multiple occasions during an LPA visit to the home, which poses a potential health, safety or personal rights risk to children in care.
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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: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024


LIC809 (FAS) - (06/04)
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