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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419424
Report Date: 06/01/2026
Date Signed: 06/01/2026 03:59:19 PM

Document Has Been Signed on 06/01/2026 03:59 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHADDAIE FAMILY CHILD CAREFACILITY NUMBER:
197419424
ADMINISTRATOR/
DIRECTOR:		SHADDAIE, FARZANEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 657-2614
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 13DATE:
06/01/2026
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:34 AM
MET WITH:FARZANEH SHADDAIETIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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On 06/01/2026 at 11:34 a.m., Licensing Program Analysts (LPAs) DeCondia Ferguson and Elicia Calvillo returned to Shaddaie Family Child Care to continue the Unannounced Annual Required Inspection initiated on 05/27/2026.

LPAs met with Licensee Farzaneh Shaddaie and discussed the purpose of the visit. LPAs continued use of the Family Child Care Home Annual Inspection Tool and completed review of inspection components that were not fully assessed during the initial inspection due to time constraints.

A census was taken during today's inspection. There were 13 children present, 4 infants and 9 preschool-age children. Also present were the Licensee and 2 assistants. Based on observations made during today's inspection, the facility was operating within licensed capacity and age limitations.

LPAs observed all required licensing postings to be prominently displayed and in compliance with licensing requirements. Telephone service was evaluated and found to be operational. Emergency contact information was reviewed and current telephone numbers were confirmed.

The current facility sketch maintained by the facility was inspected for accuracy and reflected the on-limit and off-limit areas utilized for child care services.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2026
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)
Page: 2 of 13
Document Has Been Signed on 06/01/2026 03:59 PM - It Cannot Be Edited


Created By: Decondia Ferguson On 06/01/2026 at 12:55 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(k)
Criminal Record Clearance
(k) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 2 persons did not have documentation of criminal record clearances or criminal record exemptions on file which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/02/2026
Plan of Correction
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Licensee states that the 2 staff will complete criminal record clearance by plan of correction due date of 06/02/2026.
Type A
Section Cited
CCR
102416.3(a)(1)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (1) Conversion of a garage (either attached or detached) into a "child care" room.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 11 out of 13 children were sleeping in the covereted garage and licensee was unable to provide permit documentation which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/02/2026
Plan of Correction
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Licensee states children will not nap in converted gargage until proof of permit has been submitted. Children will sleep in the lunch/bedroom of the main house as identified on the facility sketch.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Decondia Ferguson
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2026


LIC809 (FAS) - (06/04)
Page: 3 of 13
Document Has Been Signed on 06/01/2026 03:59 PM - It Cannot Be Edited


Created By: Decondia Ferguson On 06/01/2026 at 12:55 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(f)
Infant Safe Sleep
An infant shall not be swaddled while in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 1 out of 1 infant shall not be swaddled while in care, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2026
Plan of Correction
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Licensee states the use of sleep sacks will no longer be used. Licensee will notify parents that the use of sleep sacks is not allowed in a family child care home by the plan of correction due date.
Type B
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 1 out of 1 child was not supervised while they were sleeping and did not adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2026
Plan of Correction
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Licensee states they will ensure infants are under supervision when napping and will not be left unattended with the doors completely closed. Licensee wil have infants supervised by herself or an assistant when napping by plan of correction date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Decondia Ferguson
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2026


LIC809 (FAS) - (06/04)
Page: 4 of 13
Document Has Been Signed on 06/01/2026 03:59 PM - It Cannot Be Edited


Created By: Decondia Ferguson On 06/01/2026 at 12:55 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2026

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 observation and record review, the licensee did not comply with the section cited above in 3 out of 3 persons did not complete the mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2026
Plan of Correction
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Licensee stated she will submit Mandated Reporter certificates for 3 of 3 staff. Email LPA certificate of completion by plan of correction date.
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review, the licensee did not comply with the section cited above in 2 of 2 personnel records were not readily available to the department upon request, 3 of 3 personnel did not have Pediatric CRP and First Aid which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/15/2026
Plan of Correction
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Licensee stated she will submit Pediatric CPR and First Aide certificates for 3 of 3 staff. Email LPA certificate of completion by plan of correction date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Decondia Ferguson
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2026


LIC809 (FAS) - (06/04)
Page: 5 of 13
Document Has Been Signed on 06/01/2026 03:59 PM - It Cannot Be Edited


Created By: Decondia Ferguson On 06/01/2026 at 12:55 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 3out of 3 staff did not have immunizations of file against influenza, pertussis, and measles, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/15/2026
Plan of Correction
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Licensee states staff along with herself will provide proof of immunizations against influenza, pertussis, and measles by plan of correction due date.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 4 out of 4 children's records did not contain LIC9227 Infant Sleep Plan on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/15/2026
Plan of Correction
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Licensee states she will provide LIC9227 to parents and will place in children's files and email to LPA by plan of correction due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Decondia Ferguson
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2026


LIC809 (FAS) - (06/04)
Page: 6 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424
VISIT DATE: 06/01/2026
NARRATIVE
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A walk-through inspection of the home was conducted. Areas accessible to children were observed to be clean, organized, and free of hazards. Furniture and equipment appeared to be in good repair. Age-appropriate toys, materials, and equipment were available for children in care. Trash containers were observed to have tight-fitting lids. Cleaning compounds, detergents, medications, and other hazardous items were stored in a manner inaccessible to children. Floors were observed to be clean and maintained in a safe condition.

Heating, lighting, and ventilation were evaluated and found to be adequate. Per Licensee, smoking is prohibited on the premises. Per Licensee, there are no firearms or ammunition maintained in the home. No bodies of water were observed on the premises. Transportation services are not provided.

Napping arrangements were reviewed during the inspection. LPA’s observed children sleeping in the converted garage activity area. On previous inspection visits it was noted that “Licensee was advised that there is to be no sleeping, napping, eating in a garage or detached room(s).” LPA’s issued a Type A Citation for section CCR 102416.3(a)(1) Alterations to Existing Building or Grounds.

Bedding was observed to be stored separately and identified for individual use. The Licensee stated that parents provide blankets and sheets, which are taken home weekly for laundering. Additional linens are maintained on-site for use as needed.

Infant sleeping equipment was observed during the inspection. Cribs were observed to be clean, in good repair, and equipped with firm mattresses and fitted sheets. No loose blankets, pillows, bumper pads, stuffed toys, or other prohibited items were observed in the cribs at the time of inspection. LPA’s observed the use of an infant in a sleep sack. A Type B Citation is issued for CCR 102425(f) Infant Safe Sleep

During the inspection, LPAs observed an infant sleeping in a crib. The infant appeared comfortable and was observed resting on a firm mattress.

Page 2
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026
LIC809 (FAS) - (06/04)
Page: 11 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424
VISIT DATE: 06/01/2026
NARRATIVE
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During the inspection conducted on 05/27/2026, LPA Ferguson observed an infant sleeping in a crib located in a bedroom with the bedroom door closed and the adjoining door leading to the living room also closed. LPA discussed supervision requirements with the Licensee and advised that children must remain under visual supervision at all times while in care. Sleep practices were discussed with the Licensee. Additional information regarding supervision practices will be reviewed and documented upon completion of the inspection. LPA’s issued a Type B Citation for section CCR 102425(j)(5) Infant Safe Sleep.

The designated isolation area for ill children is located in the living room. Per Licensee when children are ill parents are called immediately. Per Licensee, Incidental Medical Services (IMS) are not currently being provided. Licensee was advised that an IMS plan must be submitted to the Department prior to providing IMS services.

LPAs observed tamper-resistant electrical outlets installed throughout the home. Fire extinguishers were observed and appeared to be maintained in compliance with applicable requirements. The facility's first aid kit was reviewed and observed to be fully stocked and readily available for use.

Smoke and carbon monoxide detectors were observed to be operable but was located on the dining room table not affixed to the wall. LPA’s advised replacing. Licensee stated she will have her son attach.

Bathroom and toileting areas were inspected. The facility maintains operational flush toilets for children and staff. Toileting areas were observed to be clean, adequately ventilated, and supplied with toilet paper and paper towels. Sinks and toilet facilities were readily accessible to children in care. LPAs observed several potty training chairs located in the outdoor play area. LPAs discussed toileting procedures with the Licensee. Per Licensee, potty chairs are cleaned and sanitized after each use and temporarily stored outdoors for drying prior to reuse. Additional potty chairs were observed stored in an outdoor storage closet. Equipment appeared clean and maintained in a sanitary condition at the time of inspection.

Outdoor play areas were inspected and observed to be free of hazards and debris. Outdoor equipment appeared to be maintained in a safe condition. Required cushioning material was present beneath climbing equipment. Adequate shade was available in the outdoor activity space. LPA’s observed a trampoline in the play area.

Page 3
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026
LIC809 (FAS) - (06/04)
Page: 12 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424
VISIT DATE: 06/01/2026
NARRATIVE
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Food preparation and storage areas were observed to be clean and maintained in a sanitary condition. Per Licensee, the facility provides breakfast, lunch, and two snacks daily. The refrigerator was observed to maintain safe temperatures. Cleaning agents and other hazardous substances were stored separately from food supplies. The kitchen is off limits to children.

LPAs reviewed the facility's children's roster and compared the information to enrollment records and children present during the inspection. The roster was not current and did not accurately reflect all children enrolled in care. Licensee was advised that children's rosters must be maintained accurately and updated as enrollment changes occur to ensure emergency information and facility records remain current.

Children’s records were reviewed for LIC700 - Identification and Emergency Information, LIC627- Consent for Medical Treatment, LIC995A - Notification of Parents’ Rights, LIC702 - Health History and Immunizations and were found to be complete. During record review LPA’s observed 4 of 4 did not contain LIC9227 Infant Sleep Plan. A Type B Citation for CCR 102425(c) Infant Safe Sleep.

LPAs reviewed 2 of 2 personnel records were not readily available to the department upon request and 3 of 3 personnel did not have Pediatric CPR and First Aid. A Type B Citation was issued for CCR 102416.1(a) Personnel Records. LPA’s observed 3 of 3 personnel records did not 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. A Type B Citation for CCR 1596.8662(b)(1) Administration of Child Day Care Licensing was issued.

During a review of Marcella Antoineta and Flor Ivon Chavez Gonzalez’ personnel records and Guardian records conducted on 06/01/2026, LPAs determined that Assistant(s) present at the facility and providing care and supervision to children did not 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 Type A Citation for CCR 102370(k) Criminal Record Clearance was issued along with a Civil Penalty of $1000 was assessed. LPA's confirmed with Licensee that assistants have been working at the home for a week.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026
LIC809 (FAS) - (06/04)
Page: 13 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424
VISIT DATE: 06/01/2026
NARRATIVE
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During record review LPA’s observed 3 of 3 personnel did not been immunization against influenza, pertussis, and measles on file. A Type B Citation for HSC 1597.622(a)(1) General Provisions and Definitions was issued.

LPAs discussed criminal record clearance requirements with the Licensee and advised that all adults who are employed, reside in, or provide services in a licensed child care facility and have contact with children must obtain a criminal record clearance and be associated to the facility prior to working in the licensed child care program.

The Licensee was reminded that CPR/First Aid and Mandated Reporter training must be renewed every two years.

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. LPA discussed the Community Care Licensing website www.ccld.ca.gov which provides access to resources such as forms, regulations, Provider Information Notices (PINS), and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 101212).

Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco on the premises. Licensee states there is no smoking in the facility.

The following were also discussed with the licensee:

Criminal Record Clearance: - Licensee Farzaneh Shaddaie 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.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026
LIC809 (FAS) - (06/04)
Page: 10 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424
VISIT DATE: 06/01/2026
NARRATIVE
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Assembly Bill 633: Upon receipt of a citation for a Type A Deficiency, the director shall post the licensing report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report (LIC 809D/9099D) to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:

Safe Sleep: - LPA discussed the safe sleep regulations with Licensee Farzaneh Shaddaie and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee Farzaneh Shaddaie of the importance of checking for and removing any 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.



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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026
LIC809 (FAS) - (06/04)
Page: 9 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424
VISIT DATE: 06/01/2026
NARRATIVE
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Incidental Medical Services (IMS): - Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/.

California Department of Social Services | Community Care Licensing Division
300 Continental Blvd. Suite 290 A
El Segundo, CA 90245

Type A Citation and Posting Requirement: - LPAs DeCondia Ferguson and Elicia Calvillo informed Licensee Farzaneh Shaddaie that this report dated 06/01/2026 document(s) 2 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs DeCondia Ferguson and Elicia Calvillo informed the Licensee Farzaneh Shaddaie to provide a copy of this licensing report dated 06/01/2026 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

MyChildCarePlan.org: – Licensee Farzaneh Shaddaie was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law: - During the exit interview, the Licensee Farzaneh Shaddaie, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS 06/01/2026.

Page 7
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026
LIC809 (FAS) - (06/04)
Page: 8 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHADDAIE FAMILY CHILD CARE
FACILITY NUMBER: 197419424
VISIT DATE: 06/01/2026
NARRATIVE
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Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com.

Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university.



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

At this time, citations are being issued today. See LIC 809D. Based on deficiencies identified during the inspection, including recordkeeping, staff documentation, supervision, and administrative compliance concerns, the Licensee may benefit from additional technical assistance. A referral to the Technical Support Program (TSP) is being recommended to provide consultation regarding licensing requirements, recordkeeping systems, staff documentation requirements, supervision practices, and ongoing compliance with Title 22 regulations.

A notice of site visit was given and must remain posted for 30 days. This report shall be made available to the public upon request.

Appeal Rights provided

Exit interview conducted and report was reviewed with the Licensee Farzaneh Shaddaie.



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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026
LIC809 (FAS) - (06/04)
Page: 7 of 13