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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197493765
Report Date: 07/21/2021
Date Signed: 07/21/2021 11:43:01 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2021 and conducted by Evaluator Angelica Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210506110318
FACILITY NAME:NASIR FAMILY CHILD CAREFACILITY NUMBER:
197493765
ADMINISTRATOR:NASIR, SHAHINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 456-4080
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 1DATE:
07/21/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Shahina Nasir TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Provider does not provide adequate supervision while children are in care.
INVESTIGATION FINDINGS:
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On 7/21/2021 at 11:00 AM Licensing Program Analyst (LPA) Angelica Ramirez conducted an unannounced inspection at the Nasir Family Child Care. Upon arrival, LPA met with Licensee, Shahina Nasir. The purpose of today’s inspection is to deliver the findings of the complaint received in the El Segundo Regional Office (ESRO) on 5/6/2021 regarding the allegation referenced above. LPA Ramirez is delivering the complaint findings for this report in place of LPA Mitchell who is currently unavailable. Prior to entry into the facility, LPA sanitized hands, wore a face mask, and conducted a health screening with the licensee. LPA observed a total of one child with licensee. Also present is Individual #1 and #2. All adults have a criminal record clearance. Individual #1 assisted LPA with translating for licensee.

Based on interviews conducted by LPA Mitchell with the licensee and relevant parties, LPA Mitchell was unable to determine if there was an incident involving lack of supervision, therefore the allegation is Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 30-CC-20210506110318
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NASIR FAMILY CHILD CARE
FACILITY NUMBER: 197493765
VISIT DATE: 07/21/2021
NARRATIVE
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A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation occurred.

LPA Ramirez advised Ms. Nasir that the complaint may be reopened if new evidence is received at a later date.

An exit interview was conducted with Ms. Nasir. A copy of this report and a Notice of Site Visit were issued to the licensee. The Notice of Site Visit is to be posted in a prominent area for 30 days.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2