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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494967
Report Date: 04/21/2026
Date Signed: 04/21/2026 12:58:06 PM

Document Has Been Signed on 04/21/2026 12:58 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:SHAMSUDDIN & SHAMSUDDIN FAMILY CHILD CAREFACILITY NUMBER:
197494967
ADMINISTRATOR/
DIRECTOR:		TABINDA & KARIM SHAMSUDDINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 985-1765
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
04/21/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:TABINDA & KARIM SHAMSUDDIN, LICENSEESTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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On 04/21/2026, Licensing Program Analyst (LPA) Lisa Clayton arrived at the Shamsuddin Family Child Care home to conduct the Required 3-year inspection. Upon arrival, LPA Clayton was greeted by Licensees Tabinda and Karim. LPA Clayton observed 8 children (3 infants and 5 toddlers) being supervised and cared for appropriately by both licensees and 2 fingerprint cleared assistants.

Hours of operation are Monday through Friday 8:00 am – 5:00pm. The Family Child Care home provides care to children ages 6 months – 5 years of age. Licensees provides breakfast, lunch, snacks, and water.

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 (napping room), bedroom #5/kitchenette (napping room), bathroom #4, family room (daycare activity/eating room), and the fenced backyard. The ISOLATION AREA will be in the day care activity room.

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). In the basement, the off-limits areas are: the kitchenette (inside bedroom #5 inaccessible by child safety gate), 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.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Lisa Clayton
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2026
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)
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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: 04/21/2026
NARRATIVE
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Furniture and equipment in the home are in good condition and free of sharp, loose, or pointed parts. LPA Clayton observed age-appropriate toys, books and furnishings. All areas around and under high climbing equipment, swings, slides and other similar equipment has a surface area that absorbs falls.

LPA Clayton observed that all detergents, cleaning compounds, medication, poisons and other hazardous items are inaccessible to children in care.



LPA Clayton observed disaster drills log where licensee is documenting the disaster drills per Title 22 regulations.

LPA Clayton observed a 3A:10BC Fire extinguisher, and a working carbon monoxide/smoke detector combo in the main day care room. LPA Clayton advised licensee Karim to purchase a new Fire extinguisher as the one in the home was last inspected in April 2023.

Both Licensees Mandated Reporter training expired in 2025. Licensees CPR/First Aid certifications expire in May 2026. LPA Clayton advised Licensee Karim to renew the CPR/First Aid with either the American Heart Association or Red Cross.

LPA Clayton reviewed 8 children’s files and observed them to be in compliance with Title 22 regulations for family child care homes. LPA Clayton reminded Licensee Karim to complete the Blue immunization cards (California School Immunization Record (CDPH 286).

LPA Clayton reviewed sleep logs for infants and reminded Licensee Tabinda to document the full date and sleeping position on the Sleep logs. LPA Clayton reminded licensee to check 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 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.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Lisa Clayton
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
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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: 04/21/2026
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Incidental Medical Services (IMS) policy was discussed, and IMS Services are not currently being provided. An IMS sample was provided. 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/.

LPA Clayton reminded Licensee 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

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&Rs) throughout California.

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.

During the exit interview, Licensee Karim confirmed that there are no Registered Sex Offenders living in the facility and LPA Clayton completed the RSO profile in FAS.

Per Title 22 Regulations and Health and Safety Codes, 2 (two) Type B Deficiencies were cited, no Technical Violations were issued today. Licensee Karim will forward copies of the Mandated Reporter Certificates for himself, Tabinda and all staff as well as completed Blue Cards for the students no later than May 1, 2026.



Exit interview was conducted, this report was reviewed and provided to Licensee Karim. LPA Clayton posted a Notice of Site visit which is to remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Lisa Clayton
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/21/2026 12:58 PM - It Cannot Be Edited


Created By: Lisa Clayton On 04/21/2026 at 12:46 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: SHAMSUDDIN & SHAMSUDDIN FAMILY CHILD CARE
FACILITY NUMBER: 197494967

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2026

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 LPA Clayton observation and review of the expired Licensee certificates and Licensee Karim's acknowledgement that the staff have not taken the course, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/01/2026
Plan of Correction
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Licensee Karim stated that Licensee Tabinda, both assistants and himself will take the training and provide certificates of completion to LPA Clayton and the Department via email no later than May 1, 2026.
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Based on LPA Clayton observation, file review and Licensee Karim's acknowledgement, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/01/2026
Plan of Correction
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Licensee Karim stated that he will forwards copies of completed Blue Immunization cards to LPA Clayton and the Department via email no later than May 1, 2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karren Starks
NAME OF LICENSING PROGRAM MANAGER:
Lisa Clayton
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2026


LIC809 (FAS) - (06/04)
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