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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494967
Report Date: 06/13/2022
Date Signed: 06/13/2022 09:03:18 AM

Document Has Been Signed on 06/13/2022 09:03 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHAMSUDDIN & SHAMSUDDIN FAMILY CHILD CAREFACILITY NUMBER:
197494967
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
06/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Tabinda ShamsuddinTIME COMPLETED:
08:59 AM
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On 6/13/2022 at 8:45 a.m. Licensing Program Analyst (LPA) Doris Whitmore made an announced visit for the purpose observing corrections that were needed from the Pre-licensing inspection conducted on 06/01/22.

LPA met with applicant. Tabinda Shamsuddin and the following was observed to have been corrected:

Tweezers, thermometer, & scissors were added to the First Aid Kit

Child safety latches were observed on the kitchen drawers, making them inaccessible.

Gates were observed to the stairs that leads to the outdoor area

Downstairs in Room#1 exposed Pipes were covered

Postings on Parent Board observed all required documents.

Based upon today's inspection the facility will be licensed after managerial review.

Exit interview conducted and a copy of this report was provided to the applicant.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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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