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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500451
Report Date: 07/22/2026
Date Signed: 07/22/2026 01:09:04 PM

Document Has Been Signed on 07/22/2026 01:09 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SHAHID, FARAHFACILITY NUMBER:
344500451
ADMINISTRATOR/
DIRECTOR:		SHAHID, FARAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 468-4971
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
07/22/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Farah ShahidTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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LPAs Beckby and Khashe met with Licensee, Farah Shahid for a case management visit. Licensee and assistant/husband were supervising 8 children including 3 infants (8m, 21m, 16m).

On 07/22/2026, LPA Khashe observed loose articles (sleep sack and baby bottle) in the crib where an infant was sleeping. The backyard has a playground structure with manufacturer label stating use for ages 3-10 yrs old and an infant swing labeled for 2 yrs. LPAs witnessed children under age 2 in the swing without an adult at close proximity, and the play structure is not bolted down. Upon inspection of the playground structure, an active wasp nest was observed on the top corner where the infant swing is located. LPA’s observed chemicals (fertilizer, weed killer, car oil and waterproofing stain & sealer) on the floor in the side yards. Although these areas are off limits, they were not blocked off and the chemicals are accessible to children.

LPA informed Licensee, Farah Shahid that this report dated July 22, 2026, documents three (3) Type A citations that are an immediate Health and Safety, or Personal Rights risk to persons in care. A separate 809D is issued for each deficiency.

Upon receipt of a Type A deficiency Licensee shall post the report for 30 days in addition to the Notice of Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and Licensee will obtain a signed Acknowledgment of Licensing Reports (LIC 9224) from parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.

Bettina Engelman
Corina Beckby
DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2026
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 07/22/2026 01:09 PM - It Cannot Be Edited


Created By: Corina Beckby On 07/22/2026 at 11:37 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SHAHID, FARAH
FACILITY NUMBER: 344500451

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/23/2026
Section Cited
CCR
102425(b)

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Infant Safe Sleep- Cribs or play yards shall be free from all loose articles and objects. This requirement was not met, evidenced by Licensee having a sleep sack and baby bottle in the crib with a sleeping infant. This is
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Licensee will remove all loose articles from all cribs and return the sleep sacks to the parents. Licensee and assistant will watch department video regarding safe sleep, submit a summary of video and statement that
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an immdediate health and safety risk for infants.
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they understand and will comply with all safe sleep regulations.
Type A
07/23/2026
Section Cited
CCR102417(d)

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Operation of a Family Child Care Home-The home shall provide safe toys, play equipment and materials.This requirement was not met, evidenced by Licensee allowing children under the age of 3, on the
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Children will not be allowed on the playstructure until the playstucutre is bolted down and secure after sanding and painting the structure. An age appropriate structure will be purchased in the future for the children under 3 yrs old.
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strucuture. Per manufacturer label on swing set, the structure is intended for ages 3-10yrs old. An active wasp nest was observed on 1 corner of the playstructure making it an immediate risk to the health and safety of the children.
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The wasp nest will be removed by the end of day.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Corina Beckby
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/22/2026 01:09 PM - It Cannot Be Edited


Created By: Corina Beckby On 07/22/2026 at 11:57 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SHAHID, FARAH
FACILITY NUMBER: 344500451

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/23/2026
Section Cited
CCR
102417(g)(4)

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Operation of a Family Child Care Home- (g)The home shall be free from...conditions which might endanger a child. Safety precautions shall include but not be limited to: (4)
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Licensee will remove and properly store chemicals and will begin a daily inpsection log of the backyard before children arrive every day
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Poisons...cleaning compounds... and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement was not met evidenced by having fertilizer, motor oil, sealant and weed killer accesible to children in the side yards that were not barricaded.
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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.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Corina Beckby
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
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