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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421865
Report Date: 09/11/2025
Date Signed: 09/11/2025 11:02:30 AM

Document Has Been Signed on 09/11/2025 11:02 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:AYCHILUHIM, TEGESTFACILITY NUMBER:
013421865
ADMINISTRATOR/
DIRECTOR:		AYCHILUHIM, TEGESTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 200-1956
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
09/11/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Tegest AychiluhimTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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On September 11, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Elimika Woods met with licensee Tegest Aychiluhim for an unannounced annual/random inspection. LPA disclosed the purpose of the visit and toured the facility inside and outside to conduct a health and safety inspection. Present during the inspection were the licensee’s two fingerprint cleared assistant and eight preschool-age children. The facility operates Monday through Friday from 7:30 AM to 5:30 PM.

This two story home consists of five bedrooms, three bathrooms, a living room, dining room, kitchen, office, front yard, backyard, and a detached two car garage. The home was observed to be clean and orderly with centralized heating and ventilation to ensure safety and comfort. The licensee stated that there are no weapons, including firearms, in the home. When asked about transportation, the licensee reported that she does not transport children in care.

At 8:25 AM, LPA inspected the cabinets and drawers in all on-limit areas, which include the childcare room, designated napping bedroom, two downstairs bathrooms, kitchen, and other accessible areas. No hazardous materials or toxins were observed to be accessible to children during the inspection. The home has a working telephone and a fully charged 3A40BC fire extinguisher, which meets State Fire Marshal standards, mounted on the kitchen wall. The licensee also showed LPA the first aid kit, which is kept in the kitchen.



On- Limit areas are the: Childcare room, napping bedroom, two downstairs bathrooms, kitchen, front and backyard area.
The Isolation area of the home will be a section of the childcare room, away from other children in care.

Off- Limit areas are the: The main living quarters of the home (right side) separate from the main day-care rooms and the garage.
The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision.

See 809-C for continuance.
NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Elimika Woods
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2025
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.

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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: AYCHILUHIM, TEGEST
FACILITY NUMBER: 013421865
VISIT DATE: 09/11/2025
NARRATIVE
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At 8:40 AM, LPA inspected the front and backyard areas to ensure there were no pools, hot tubs, or other bodies of water that would violate childcare licensing laws. None were observed during today’s inspection. LPA tested the dual smoke and carbon monoxide detector located in the hallway and confirmed it was functioning properly. Both the front and backyard areas are fully fenced and were observed to be free from defects or dangerous conditions. A gate/barrier is in place at the bottom of the front yard stairs to prevent children five years or younger from accessing the upper floor.

During today’s inspection, LPA observed multiple slides that are anchored to the ground, including a swing-and-slide structure with cushioning underneath to absorb falls. There are ample age-appropriate toys, including bicycles, tricycles, and electric ride-on equipment, all of which appeared to be in safe and good condition. The front yard play area also includes a basketball court, as well as benches, chairs, and tables where children can rest after play.

At 8:10 AM, LPA requested and reviewed the files of four (4) children and one staff member. All children’s files were complete with the required Identification & Emergency Information, Parent’s Rights, and Medical Consent forms, among others. The staff file reviewed contained the required Employee Rights form and Statement Acknowledging Requirement to Report Child Abuse. LPA also verified that the licensee is in compliance with immunization laws pertaining to all childcare providers.


Fire and disaster drills are conducted and documented twice a year, with the most recent drill completed on 06/02/2025. The licensee’s Health and Safety training is incomplete, and her CPR and First Aid certification has expired. The licensee and her assistants have not yet renewed their Mandated Reporter training but stated they will register for the class today. All required postings were observed to be current and visible for public review.

Effective August 1, 2003, California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. The licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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)/ (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/.

See 809-C for continuance.
NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Elimika Woods
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: AYCHILUHIM, TEGEST
FACILITY NUMBER: 013421865
VISIT DATE: 09/11/2025
NARRATIVE
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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-andresources/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.

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 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.

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.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The following deficiencies were observed during today’s inspection:

  • At 9:00 AM, LPA observed that Staff #1 (S1), Staff #2 (S2), and the licensee have not renewed their Mandated Reporter training.
  • At 9:30 AM, LPA observed that the licensee has not renewed her CPR and First Aid certification.

See 809-D for deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee
NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Elimika Woods
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/11/2025 11:02 AM - It Cannot Be Edited


Created By: Elimika Woods On 09/11/2025 at 10:31 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AYCHILUHIM, TEGEST
FACILITY NUMBER: 013421865

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 which the licensee, S1, and S2 did not complete their renewal which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2025
Plan of Correction
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The licensee and assistants will complete Mandated Reporter training and send their certificates to LPA by 09/18/25, by email, fax or text message.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

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 which she did not complete her renewal of CPR & first aid training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2025
Plan of Correction
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Licensee will complete CPR & first aid training and send her certificate to LPA by 09/25/25, by email, fax, or text message.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Chandra Charles
NAME OF LICENSING PROGRAM MANAGER:
Elimika Woods
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2025


LIC809 (FAS) - (06/04)
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