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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417058
Report Date: 05/07/2026
Date Signed: 05/07/2026 01:47:56 PM

Document Has Been Signed on 05/07/2026 01:47 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BAMREC PRESCHOOLFACILITY NUMBER:
434417058
ADMINISTRATOR/
DIRECTOR:		MAHA DAHBOURFACILITY TYPE:
850
ADDRESS:445 LEIGH AVENUETELEPHONE:
(408) 796-7740
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 18DATE:
05/07/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Maha Dahbour - DirectorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 05/07/2026, Licensing Program Analyst (LPA), Jennifer “Jen” Beehler conducted an unannounced Annual/Random inspection. LPA was granted access to the facility by the Licensee and toured both indoors and outdoors during the inspection. Upon arrival, there were 18 children (preschool-age) and 6 staff (3 - teachers / 2 - aides/ 1 - Director) present, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings near the entrance to the facility. Hours of operation for the facility are Monday – Thursday, 08:00AM-05:00PM and Friday 8:00AM-3:00 PM. The facility has an active waiver to limit only 14 children on the play ground at one time. LPA observed all conditions were met during the inspection.

Licensee was reminded that all adults 18 and over, 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 Child Care Center. 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.

LPA observed the Guardian Roster missing five (5) staff members present. It was determined, the Licensee was using the incorrect criminal background check form. The staff members were background checked for the Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI), but did not have the Child Abuse Central Index (CACI) checked because the form used was not from Community Care Licensing. LPA reviewed the process with the Licensee and discussed next steps.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2026
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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Document Has Been Signed on 05/07/2026 01:47 PM - It Cannot Be Edited


Created By: Jennifer Beehler On 05/07/2026 at 11:31 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BAMREC PRESCHOOL
FACILITY NUMBER: 434417058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in 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 in 5 out of 6 staff present which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/08/2026
Plan of Correction
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Licensee to provided a written plan, by POC due date, on how staff will get Criminal Record Clearance and added to the Guardian Roster. Licensee to include in the plan how they will address this moving forward so they always remain in compliance.
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.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Jennifer Beehler
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/07/2026 01:47 PM - It Cannot Be Edited


Created By: Jennifer Beehler On 05/07/2026 at 11:31 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BAMREC PRESCHOOL
FACILITY NUMBER: 434417058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, the licensee did not comply with the section cited above in 1 out of 2 play structures had wooden stairs that were not safely attached to the structure which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/21/2026
Plan of Correction
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By POC due date, Licensee to repair the structure and provide photographic proof. Licensee to complete periodic checks on facility equipment to ensure it is functioning and safe for day care children at all times.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

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 in 4 out of 5 staff did not have valid Mandated Reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/21/2026
Plan of Correction
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Staff to complete Mandated Reporter training that satisfies the requirement of AB1207. Licensee to provide proof to LPA by POC due date. Licensee to create a written plan on how facility will track staff training to ensure future compliance.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Jennifer Beehler
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/07/2026 01:47 PM - It Cannot Be Edited


Created By: Jennifer Beehler On 05/07/2026 at 11:31 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BAMREC PRESCHOOL
FACILITY NUMBER: 434417058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

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 in 5 out of 5 staff files were missing required documentation such as Health screening, TB test, Immunization records to MMR/TDAP or Influenza which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/21/2026
Plan of Correction
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Licensee to provide LPA with proof, prior to POC due date of staff files complete. This includes an LIC503 Health Screening and Negative TB Test/TB Assessment to be completed within one year of employment or sooner. Immunization records for Measles and TDAP along with influenza vaccination or declination. Licensee to include a written plan on how staff files will be maintained in the future to ensure constant compliance.
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, the licensee did not comply with the section cited above in 2 out of 16 children which poses a potential health, safety or personal rights risk to persons in care. LPA observed a parent ask staff to sign in two children. Staff complied and used the electronic sign in to log children into the facility for the parent.
POC Due Date: 05/11/2026
Plan of Correction
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Licensee to communicate with parents of the importance and regulatory requirement that authorized representatives are required to sign their children in/out. This should include authorized representatives full legal name and time and date of pick up or drop off. Licensee to provide LPA with proof of communications to parents and a written plan on how to address this process with parents to remain in compliance, by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Jennifer Beehler
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2026


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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BAMREC PRESCHOOL
FACILITY NUMBER: 434417058
VISIT DATE: 05/07/2026
NARRATIVE
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LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. The last fire/disaster drill was conducted on 10/03/2026, which is not compliant with the six month requirement for facilities. LPA observed a fully charged 3A40BC fire extinguisher last serviced 04/16/2026, which is compliant with state fire marshal regulations. LPA observed a fully functioning smoke detector system and a working carbon monoxide detector. Licensee states that he does not currently have any children in care who require Incidental Medical Services but does offer administration of medication when necessary. LPA observed the location for medication is stored in a place out of reach of children. LPA collected an updated Roster for the facility.

LPA observed staff signing in two children upon arrival at the request of a parent.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.
For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and overall safe for the day care children. LPA observed hallway cabinets that had adult scissors in a lower cabinet drawer that a child could access. LPA discussed alternative locations to store sharp items or locking the cabinet to ensure all potentially harmful objects could not be accessed by children in care. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. The floors were clean and free of tripping hazards. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom, not utilized by the children, which an isolated child can use if necessary. The Licensee states a working phone line is designated for the facility. Staff completes daily cleaning during facility hours. After hours staff follow a sanitation schedule to deep clean toys and equipment. A cleaning service is hired on the weekends each month for additional deep cleaning. A pest company has regular maintenance after hours. During facility breaks when children are not in care, the pest company will complete chemical treatments. The Licensee states that there are no weapons or firearms on the premises.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BAMREC PRESCHOOL
FACILITY NUMBER: 434417058
VISIT DATE: 05/07/2026
NARRATIVE
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The outdoor area of the facility was inspected and observed to be fenced in. LPA observed one of the two play structures had wooden stairs that were not secure with some split wood where it was meant to attach to the structure. LPA observed the outdoor area to be age-appropriate, and has sufficient resilient materials (rubber padding under astro turf) to absorb falls. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by canopy and trees. LPA observed food wrappers and other loose paper debris on the outdoor activity area floor. Director stated it was from yesterday's snack service.

Food is provided by the facility and is stored, prepared, and served in a safe and healthful manner to the children. Facility offers a full day program and provides midmorning snack to children. Menu is in writing and posted at least one week in advance, accessible to authorized representatives. The kitchen and storage area is clean and free of litter and rubbish. Equipment necessary for the storage, preparation and service of food is well maintained, clean, and sanitized after each use. Drinking water is readily available for children in the facility via water dispensers and children bring reusable bottles from home labeled with their names.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Lead testing was completed on 07/22/2024. LPA reminded the Licensee new lead testing would be required to be completed and the results provided to the Department by no later than 07/22/2029.

Five (5) children’s files (preschool-age) were reviewed during today’s inspection for the following records: Physician’s Report (LIC701), Notification of Parents Rights (LIC995A), Personal Rights (LIC613A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Signed Admission Agreement, and Immunization Records (PM286). LPA observed all files were missing Notification of Parent's Rights (LIC995A) and Personal Rights (LIC613A).

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BAMREC PRESCHOOL
FACILITY NUMBER: 434417058
VISIT DATE: 05/07/2026
NARRATIVE
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Five (5) staff files (3 - teachers/ 2 - aides) were reviewed for the following records: Transcripts/Verification of Experience, Health Screening Report (LIC503), Employee Rights (LIC9052), Statement Acknowledging Requirement to report Child Abuse (LIC9108), Mandated Reporter Training Certificate, Tuberculosis (TB) Clearance, and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza vaccination or statement declining influenza vaccination. There is at least one staff member present with current CPR/First-Aid that expires 10/14/2027. One out of five staff had valid Mandated Reporter training. LPA reminded Licensee that the Mandated Reporter Training must be renewed by all staff every 2 years and the course completed must meet the requirements of AB1207.

The Licensee understands that the site director shall be on the premises during the hours the center is in operation and that children at the center shall be visually supervised at all times. LPA reminded Licensee that there shall be at least one person with valid EMSA approved CPR and First-Aid certifications on site at all times or present during off site activities, such as field trips.

Licensee can find EMSA approved training courses at the following website: https://www.emsa.ca.gov/emsa?id=child_care

During today's inspection, the following documents were collected:
  • Current Facility Roster
  • Lead Testing report dated 07/22/2024


During today's inspection, the following documents were provided to the Licensee:
  • LIC9163 Live Scan Document - Community Care Licensing
  • LIC610 - Emergency Disaster Plan
  • LIC200A - Application for Child Care Center
  • LIC9224

As a result of today’s inspection, one (1) Type A Citation, five (5) Type B Citations and three (3) Technical Violations were cited. Exit interview conducted with the Licensee. Report was reviewed and provided to Licensee, Imadeddin Abdelgawad along with appeal rights.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BAMREC PRESCHOOL
FACILITY NUMBER: 434417058
VISIT DATE: 05/07/2026
NARRATIVE
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LPA informed licensee, Imadeddin Abdelgawad that this report dated 05/07/2026 documents one (1) Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the licensee to provide a copy of this licensing report dated 05/07/2026 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 Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

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.
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC809 (FAS) - (06/04)
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