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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493765
Report Date: 04/03/2024
Date Signed: 04/03/2024 03:39:13 PM


Document Has Been Signed on 04/03/2024 03:39 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



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: 4DATE:
04/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Shahina Nasir, LicenseeTIME COMPLETED:
04:00 PM
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On 4/3/2024 at 3:00pm Licensing Program Analyst (LPA), Loyce Phillips conducted a Plan of Correction visit and was met by Licensee, Shahina Nasir. LPA observed 3 children and 1 infant in care, with Licensee spouse and adult daughter. All adults have a criminal record clearance.

On 3/21/2024, Licensee was cited for heater in bedroom #2 not covered and accessible to children in care,
staff did not have Mandated Reporter Certificates and immunizations in employee files.
- LPA observed the heater in bedroom #2 made inaccessible to children in care.
- LPA observed Licensee completed Mandated Reporter training on 4/2/2024 and staff completed Mandated
Reporter on 4/3/2024.
- LPA observed all staff have immunization for MMR/TDAP and FLU on file.

All citations issued on 3/21/2024 has been cleared.

An exit interview was conducted. A copy of this report, notice of site visit, deficiencies clearance letters were discussed and provided to Licensee, Shahina Nasir.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024
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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