197494967-8-15-2023-30-CC-LCLN-CUQQ43-20230815114939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494967
Report Date: 08/15/2023
Date Signed: 08/15/2023 11:49:53 AM

Document Has Been Signed on 08/15/2023 11:49 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	SHAMSUDDIN & SHAMSUDDIN FAMILY CHILD CARE		FACILITY NUMBER:	197494967
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	08/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	TABINDA & KARIM SHAMSUDDIN, LICENSEES		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 08/15/2023, Licensing Program Analyst (LPA) Clayton made an announced visit to the Shamsuddin Family Child Care home for the purpose of conducting a Case Management Inspection for Capacity Increase. LPA Clayton also conducted the Annual/Random 1 year Required Inspection. LPA was greeted by Licensees Tabinda and Karim Shamsuddin. LPA observed 3 infants being cared for and supervised appropriately. Capacity as specified on the license is being maintained. Hours of operation are Monday through Friday 8:00a.m. to 5:00 p.m. Licensee provides snacks and water. LPA Clayton toured the home inside and outside for a Health and Safety inspection. The home is neat and clean with heating and ventilation for safety and comfort. Current facility sketch was reviewed, and LPA confirmed that this is a two-story home with 6 bedrooms, 5 bathrooms, living room, dining room, kitchen, kitchenette, fenced backyard, and detached office in the fenced backyard. Childcare is being conducted on the bottom (basement) floor only. The ON LIMIT AREAS are as follows: bedroom #4, bedroom #5, bathroom #4, family room (daycare activity/eating room), and the fenced back yard. The ISOLATION AREA will be in the day care activity room. Children will nap on cots in bedrooms #4 and #5. OFF-LIMIT AREAS are as follows: the entire first floor (living room, main kitchen, dining room, bedrooms #1, #2, and #3, bathrooms #1, #2 and #3). On the second floor, the off-limits areas are: the kitchenette, bedroom #6 and bathroom #5. The detached office in the fenced backyard is off-limits. All of which are inaccessible to children in care by closed and/or locked doors and visual supervision.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: SHAMSUDDIN & SHAMSUDDIN FAMILY CHILD CARE	FACILITY NUMBER: 197494967
	VISIT DATE: 08/15/2023

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Outdoor play area is fenced and free from defects or dangerous conditions. There are ample age-appropriate toys that are safe, clean and in good repair. The home has working telephone service and LPA confirmed the phone number is (310) 572-7793.

LPA Clayton observed a fully charged 2A10BC Fire extinguisher in the daycare activity room, a working carbon monoxide/smoke detector combo and a working smoke detector. A Fire Clearance was approved on July 18, 2023 by the LA City Fire Department Institutions Unit.

There are no pools, ponds, spas, or other bodies of water on the premises. There are no firearms or ammunition on the premises. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible to children in care.
LPA reviewed 3 children’s files and observed them to be in compliance as they contained current contact information for authorized representatives and/or relatives who can assume responsibility for the child, immunization records, and authorization for medical treatment.

Licensee’s Mandated Reporter Training and Pediatric CPR/First Aid are current. LPA Clayton reminded Licensee that the above-mentioned certifications are to be renewed every 2 years, per Health and Safety Codes and Title 22 Regulations for Child Care.

Licensee ensures that children in care are supervised at all times and is aware that children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and on file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: SHAMSUDDIN & SHAMSUDDIN FAMILY CHILD CARE	FACILITY NUMBER: 197494967
	VISIT DATE: 08/15/2023

NARRATIVE

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Incidental Medical Services (IMS) are not currently being provided. LPA Clayton provided Licensee with the IMS Plan Sample. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA reminded Licensee of the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

During the exit interview, licensee Karim Shamsuddin confirmed that there are no Registered Sex Offenders living in the home and LPA completed the RSO profile in FAS.

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. at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: SHAMSUDDIN & SHAMSUDDIN FAMILY CHILD CARE	FACILITY NUMBER: 197494967
	VISIT DATE: 08/15/2023

NARRATIVE

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No deficiencies were cited today, per Title 22 Regulations and Health and Safety Codes.

The home is approved for a Capacity Increase on today August 15, 2023.

An exit interview was conducted, a copy of this report was read and provided to the Licensee. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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