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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500362
Report Date: 03/02/2023
Date Signed: 03/02/2023 02:53:18 PM

Document Has Been Signed on 03/02/2023 02:53 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:RAHEEL, BEENISHFACILITY NUMBER:
394500362
ADMINISTRATOR:RAHEEL, BEENISHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 299-2717
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
03/02/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Beenish RaheelTIME COMPLETED:
03:00 PM
NARRATIVE
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On 03/02/23, Licensing Program Analyst (LPA) Elvira Sierra met with licensee, Beenish Raheel to follow up on the Unusual Incident Report (UIR) called into Community Care Licensing on January 20, 2023. During today's inspection LPA conducted a tour of the facility. Present in the facility was Licensee and her son caring for 11 children. During the inspection another assistant arrived to the facility and Licensee left to pick up her daughter.

Facility self-reported a UIR on 01/20/23 that occurred on 12/22/22. Facility staff failed to report the incident to the Department by telephone or fax within the Department’s next business day. Also LPA observed upon entrance that there was no gate barricading the stairs leading to the second floor. LPA provided PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect to Licensee.

Type B deficiencies are cited on the subsequent page (809-D) of this report. Exit Interview was conducted in which this report and Appeal of Rights were reviewed and discussed with licensee, Beenish Raheel. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.”
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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 2
Document Has Been Signed on 03/02/2023 02:53 PM - It Cannot Be Edited


Created By: Elvira Sierra On 03/02/2023 at 02:26 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: RAHEEL, BEENISH
FACILITY NUMBER: 394500362

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/02/2023
Section Cited
CCR
102416.2

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102416.2 Reporting Requirements
The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). This requirement was not met as evidence by;
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POC. Licensee submitted a written incident report on 01/20/23. Deficiency cleared on today's visit.
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The Department received a call from Licensee on 01/20/23 to report unusual incidents that occurred on 12/22/23. This is a violation that if not corrected can pose a health and safety risk to the children in care.

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Type B
03/02/2023
Section Cited
CCR102417(3)

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102417(3) Operation of a Family Child Care Home
(3) Where children less than five years old are in care, stairs shall be fenced or barricaded.This requirement was not met as evidence by; LPA observed no gate on the stairs leading to the upstair floor.
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POC; Licensee place a gate in the stair during today's inspection.
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This is a violation that if not corrected can pose a heath and safety risk to the 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:Bettina Engelman
LICENSING EVALUATOR NAME:Elvira Sierra
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023


LIC809 (FAS) - (06/04)
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