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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400656
Report Date: 06/03/2026
Date Signed: 06/05/2026 09:24:28 AM

Document Has Been Signed on 06/05/2026 09:24 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SHAMSIDDEEN & WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
198400656
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
06/03/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:LICENSEES' NAIMAH SHAMSIDDEEN & CHRISTOPHER WILLIAMSTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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 ***FAS save conflict error on 6/3/26, final printed on 6/5/26***
Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced random / annual inspection to the above facility and a inspection for a Capacity Increase requested by Licensees' Naimah Shamsiddeen & Christopher Williams . LPA met with Licensee Naimah Shamsiddeen & Christopher Williams who allowed LPA entrance into the facility.

Fire Inspector approved the STD850 on 5/22/26 which states approved for a Large Family Day Care up to facility of 14 children. Due to no landlord contest provided for a Large fcc the facility if and when licensed will be licensed for a Capacity of 12 children.

Naimah Shamsiddeen guided analyst on a tour of the facility. The Licensee currently operates a Small Family Day Care Home. The operating hours are be Monday through Sunday from 12:00 AM to 11:59 PM (weekends available if needed). The licensee cares for children ages: 6 weeks to 12 years old.

Per Licensees' home is a rental and uses LIC282 Affidavit Regarding Liability Insurance form. LPA observed 4 children in care upon arrival. Licensee's and an adult resident who resides in the home were present during today's visit all individuals are fingerprinted cleared.

This is a one story home. The home consist of 3 bedrooms, 2 bathrooms, classroom, living room, dining room, kitchen, garage, backyard and front yard.
Areas "off limit" to parents and children include: 2 bedrooms, 1 bathroom, kitchen, garage, front yard. Children and parents use: living room, dining room, 1 bedroom ( sleep room), classroom, 1 bathroom, and backyard. Areas used by children were inspected for safety, comfort, heating/ ventilation, cleanliness and telephone service.
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2026
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SHAMSIDDEEN & WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198400656
VISIT DATE: 06/03/2026
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The home has central heating and air conditioning, vents were observed on high to reach areas along the
home walls. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose
a danger to children are made inaccessible in cabinets in the kitchen ; kitchen area is observed to have a
safety gate to ensure kitchen is off limit. Per Licensee, currently no poisons are stored in the home and
understands poisons when brought in the home are kept locked not only inaccessible. Licensee stated
provides food for the children. Licensee's was advised that if food is brought from the children's home, all
containers must be labeled with the child's name and properly stored or refrigerated. Sleep room / bedroom
used for infants was observed there is 1 crib and 2 play yards. The crib has a firm mattress, and the play
yards had a thin pad and fitted sheets; per licensee infants use the play yards for sleeping arrangements, due to no firm mattress in infants play yards, deficiency cited.

Currently per Licensee Naimah Shamsiddeen only 1/2 of the backyard is being used, as they need to arrange and fix patio area and place hazardous items like gym equipment and bbq propane tanks inaccessible. Licensee plans to use the full back yard space and make corrections and report to caseload LPA to ensure safety of the backyard before children use the space. Back yard was observed fenced. LPA observed soft artificial grass/turf and age appropriate toys for children to use. LPA observed that there were no bodies of water on the premises. Per Licensee, children who show signs of illness waiting to be picked up by parent guardian will wait in dining room or in one of the rooms used for day care depending on the number of children in care. Per Licensees', there are no pets or firearms, weapons. LPA observed age appropriate toys and napping equipment for children. Smoke and carbon monoxide detectors were tested and are operable. Fire place was observed to have a screen that is not latched for inaccessibility, deficiency cited. Per Licensee, fire place gas is shut off and fire place does not work. LPA observed the required fire extinguisher that is fully charged and purchased within in one year, proof of receipt was observed. Disaster and Fire Drill was conducted drill on 04/13/2026.

LPA Calderon reviewed Pediatric 1st aid and cpr for Licensees'- C.Wlliams expires 11/2026 and
N.Shamsidden expires 11/2026 and Mandated Reporter certificate for C.Williams expires 11/19/26 and
N.Shamsidden expires 1/7/27.

LPA reviewed (3) children's records. 2 children present were infants. Infant children's 15 min sleep log was
observed to be inconsistent with dates and times for Child #1 and Child #2, deficiency cited.
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SHAMSIDDEEN & WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198400656
VISIT DATE: 06/03/2026
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The following corrections to be submitted by 6/12/26: Photos of fireplace with secured screen, 2 mattresses and fitted sheets for play yards and consistent sleep logs for infants 15 min check for child #1 and child #2.
  • 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.
  • Licensee 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.
  • LPA discussed the safe sleep regulations with licensee 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 of the importance of checking for 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.
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/.
  • Licensee 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.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the
facility and LPA completed the RSO profile in FAS. Based on today's visit, Per Title 22 regulation there were
(3) deficiencies cited, Type B, provided on LIC 809-D.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was
reviewed with the licensee Naimah Shamsidden, informed applicant approval for a Large Capacity will be
determined upon correction completion and per review by the Department.
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 06/05/2026 09:24 AM - It Cannot Be Edited


Created By: Ashley Calderon On 06/03/2026 at 12:35 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SHAMSIDDEEN & WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198400656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation by LPA Calderon Fire place was observed to have a screen that is not latched for inaccessibility, thelicensee did not comply with the section cited above in [1] out of [1] fire place that was not inaccessible which poses apotential health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Licensee online purchased item for screen inaccessibility for the fireplace and will send photos to LPA Calderon by poc duedate.
Type B
Section Cited
CCR
102425(a)(3)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review child #1 and child #2 did not have consistent sleep log 15 min checks documentation, the licenseedid not comply with the section cited above in [2] out of [2] infant documentation which poses a potential health, safety orpersonal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Licensee will conduct 15 min checks consistently and document and send copy of 15 min log to LPA Calderon by poc duedate.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2026


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 06/05/2026 09:24 AM - It Cannot Be Edited


Created By: Ashley Calderon On 06/03/2026 at 12:35 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SHAMSIDDEEN & WILLIAMS FAMILY CHILD CARE
FACILITY NUMBER: 198400656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2026


LIC809 (FAS) - (06/04)
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