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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500362
Report Date: 06/15/2022
Date Signed: 06/15/2022 11:26:09 AM

Document Has Been Signed on 06/15/2022 11:26 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:RAHEEL, BEENISHFACILITY NUMBER:
394500362
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
06/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Beenish RaheelTIME COMPLETED:
11:35 AM
NARRATIVE
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Licensing program Analysts (LPAs) Christopher Jackson and Mariya Melnichuk met with the licensee Raheel Beenish for the purpose of a capacity increase from 8 to 14 children. LPAs toured all areas of the two story home that are accessible to children. Today’s census included 8 children. Also present during today’s inspection was the assistant Antonia Ochoabaez. LPAs observed the adult assistant was not cleared and associated through Community Care Licensing during today's inspection.

Off-limit areas include: Entire second floor, laundry room, pool area and garage. Licensee acknowledged that children may never enter these off-limit area. LPAs reviewed four of the enrolled children files during today's inspection and observed the files kept according to Title 22 regulations. LPAs observed the fire drill log and observed a drill was conducted at least once every 6 months. LPAs observed a functioning smoke and carbon monoxide detector and working 3A40 BC fire extinguisher. LPAs toured the pool area and observe a Five foot high see through fence, with a gate that opens away from the body of water and self-closes and latches. LPAs observed a section of the wooden fence line that could be pulled back and potentially provide access into the pool pump area. The Fire Safety Inspection Clearance has been received on 05/31/22 from the Manteca Fire department, Sacramento, CA and the home has been cleared for up to 14 children.
Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2022
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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Document Has Been Signed on 06/15/2022 11:26 AM - It Cannot Be Edited


Created By: Christopher Jackson On 06/15/2022 at 10:39 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: RAHEEL, BEENISH
FACILITY NUMBER: 394500362

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2022
Section Cited
CCR
102370(d)(1)

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Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by, LPA observed and adult
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LPAs observed licensee remove un-fingerprinted adult from residence. Licensee said they will not allow the assistant to return until the indivual is cleared and provide proof of clearance to LPA.

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assistant working in the home that was not associated to the facility. This poses an immediate health and safety 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:Justin L Denton
LICENSING EVALUATOR NAME:Christopher Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2022


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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: RAHEEL, BEENISH
FACILITY NUMBER: 394500362
VISIT DATE: 06/15/2022
NARRATIVE
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Based on observations of the uncleared assistant during today's inspection. Title 22 Deficiencies have been cited on the attached LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files

This report was reviewed and discussed with licensee. A notice of site visit and appeal rights were provided.

As of today, Applicant understands the capacity increase was not gratned during today's inspection. The following conditions shall be met before a license will be granted:



1) Side wooden fence will be secured to prevent access into pool pump area.
2) Self closing and latching devise shall be six inches from the top of the fence.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
LIC809 (FAS) - (06/04)
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