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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500362
Report Date: 06/21/2023
Date Signed: 06/21/2023 03:46:00 PM

Document Has Been Signed on 06/21/2023 03:46 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:RAHEEL, BEENISHFACILITY NUMBER:
394500362
ADMINISTRATOR:BEENISH RAHEELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 299-2717
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
06/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Beenish RaheelTIME COMPLETED:
04:00 PM
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On 06/21/2023 at 9:45 AM, Licensing Program Analyst (LPA) Tiffanie Diep met with Licensee Beenish Raheel for the purpose of an unannounced annual inspection, and Licensee guided LPA on a tour of the home. LPA observed ten children present in the home with Licensee, their spouse, and their assistant. Licensee's operating hours are Monday through Friday from 8:00 AM to 5:00 PM.

A health and safety inspection of the home’s interior and exterior was conducted in all areas accessible to children. The off-limits areas of the home include the laundry room, entire second floor, garage, pool area, and backyard shed. LPA observed stairs to the second floor barricaded by a baby gate. LPA observed the required postings and a working phone. LPA observed a 3A40BC fire extinguisher meets regulations and verified both smoke and carbon monoxide detectors were functional. LPA toured the kitchen area and verified knives were inaccessible to children in care. LPA observed a bathroom and verified that toxic and hazardous items were inaccessible to children in care. LPA observed cleaners stored on top of refrigerator out of reach and inaccessible to children in care. LPA observed play areas with age-appropriate toys for children. Licensee stated there are no weapons in the home. LPA observed a fireplace that was barricaded. Licensee stated they do not use the fireplace and will maintain supervision to ensure children's safety. The outdoor play area was inspected and is surrounded by a wooden fence. LPA walked the perimeter of the outdoor play area during inspection and verified that the entire area is fenced in. LPA observed a play structure in the backyard. The backyard has an in-ground pool area that is fenced according to Title 22 Regulations, and LPA observed the gate to self-close and self-latch.

Continues on 809-C
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RAHEEL, BEENISH
FACILITY NUMBER: 394500362
VISIT DATE: 06/21/2023
NARRATIVE
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All individuals subject to a criminal record review have obtained a criminal record clearance. 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 five 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.

LPA reviewed five children's files, and LPA observed emergency information and required immunization records were on file. LPA observed a current roster. LPA discussed the requirement to maintain personnel records and to document fire and disaster drills at least once every six months. LPA verified Licensee's immunization records were available in the facility file. Current EMSA pediatric CPR and first aid certification was verified and expires on 10/30/2023. Mandated Reporter Training certificate expired on 01/22/2023. LPA discussed the mandated reporter training requirement and Licensee was reminded to renew the course every two years.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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. LPA observed 15-minute napping logs for infants under 24 months. LPA provided a copy of the Individual Sleeping Plan (LIC 9227) for infants under 12 months.

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) or (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/.

Continues on 809-C
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RAHEEL, BEENISH
FACILITY NUMBER: 394500362
VISIT DATE: 06/21/2023
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensee was informed of the MyChildCarePlan.org site, 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.

Because Licensee rents/leases the home, proof of landlord notification is required. LPA observed the Property Owner/Landlord Notification form (LIC 9151) that Applicant confirms was provided to the property owner/landlord. Licensee obtained a signed Property Owner/Landlord Consent Form (LIC 9149).

Based on LPA’s observations, interviews conducted, and record review, deficiencies are being cited on the attached LIC 809-D. LPA Tiffanie Diep informed the licensee, Beenish Raheel, that this report dated 06/21/2023 documents two Type A citations which shall be posted for 30 consecutive days as there was an immediate risk to the health, safety, or personal rights of children in care. LPA also informed Licensee that this report dated 06/21/2023 documents two Type B citations. Type B citations are a potential risk to the health, safety, or personal rights of children in care.

Also, LPA informed Licensee to provide a copy of this licensing report dated 06/21/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgment of Receipt of Licensing Reports (LIC 9224), or other written statement, must be placed in the child’s file for verification.

An exit interview was conducted and report was reviewed with the licensee, Beenish Raheel. During the exit interview, Licensee confirmed that there are no registered sex offenders (RSO) living in the facility and LPA completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/21/2023 03:46 PM - It Cannot Be Edited


Created By: Tiffanie Diep On 06/21/2023 at 02:45 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: RAHEEL, BEENISH
FACILITY NUMBER: 394500362

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as two out of two infant files did not contain the LIC 9227 which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2023
Plan of Correction
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 Licensee stated they will provide proof of completed LIC 9227 forms to LPA by 06/22/2023
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Chayntel Hunter
LICENSING EVALUATOR NAME:Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/21/2023 03:46 PM - It Cannot Be Edited


Created By: Tiffanie Diep On 06/21/2023 at 03:09 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: RAHEEL, BEENISH
FACILITY NUMBER: 394500362

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(d)
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for erview.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as licensee did not ensure personnel record was maintained for one out of three staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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 Licensee stated they will provide copies of required personnel documents for assistant to LPA by 07/21/2023
Type B
Section Cited
CCR
102417(g)(9)(A)1
The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the last fire and disaster drill conducted was on 09/26/2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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 Licensee stated they will provide documentation of completed drill to LPA by 07/21/2023
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:Chayntel Hunter
LICENSING EVALUATOR NAME:Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


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