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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493765
Report Date: 04/03/2024
Date Signed: 04/05/2024 11:42:49 AM


Document Has Been Signed on 04/05/2024 11:42 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
EL SEGUNDO CC RO, 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:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:TIME COMPLETED:
02:10 PM
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On 4/03/2024 Licensing Program Analyst (LPA), Ranita Richmond arrived at the above name FCCH to conduct an unannounced Required 3-Year Inspection and was met by Licensee, Shahina Nasir. LPA observed 4 children in care being cared for appropriately by two finger print cleared adults. Licensee provides 24-hour care for children. Licensee was reminded when children are awake staff must be awake.

LPA toured the home inside and outside. This is a 3 bedroom, 2 bathroom home with living room, kitchen/dining area and detached garage. The garage has been converted into a living dwelling. The property also has an ADU on the premises located in the back of the property. The ADU unit is listed as unit B with 3 bedrooms, 3 bathrooms and a kitchen.

LPA Richmond did not complete the required inspections due to required annual had been completed by LPA Loyce Phillips on 3/21/24.

Notice of site visit provided to licensee.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Ranita RichmondTELEPHONE: (424) 301-3065
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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