197494143-7-12-2019-30-CC-HESA-BDZTT3-20190712150005

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494143
Report Date: 07/12/2019
Date Signed: 07/12/2019 03:00:21 PM

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:	FUTURE FIRST AFTERSCHOOL PROGRAM		FACILITY NUMBER:	197494143
ADMINISTRATOR:	DORSEY, KY		FACILITY TYPE:	840
ADDRESS:	7615 COWAN AVE		TELEPHONE:	(310) 430-9099
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90045
CAPACITY:	50	CENSUS: 0	DATE:	07/12/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Obaid Yousufzai - Applicant		TIME COMPLETED:	03:20 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 7/12/19 at 1:00PM, Licensing Program Analyst (LPA) Helen Estrella arrived at 7615 Cowan Ave, Los Angeles CA 90045 and met with applicant Obaid Yousufzai for the purpose of a scheduled prelicensing visit. The facility is housed at the school campus of Cowan Elementary School. The Future First Afterschool program is an after-school program for the students of the elementary site. The facility is requesting a capacity of 50 school age children from ages six to eleven. The program operates from Monday to Friday from 2:30 PM to 6:00 PM and Tuesdays from 1:30 PM to 6:00 PM. The applicant has a granted fire clearance from Inspector Reddick by the Los Angeles City Fire Department on 4/12/19. The after-school program will be utilizing Classroom 26, 27 in bungalow area and Library room at the elementary site for indoor study and activities. The outdoor space is the area adjacent to the bungalow that consists of basketball courts, tetherball courts, baseball diamond and play structure. Access to the Facility Parents will park in the parking space on side and front of the facility. Parents will enter through the front gate of the property to get to the entrance of the building. Sign in and sign out Applicant to ensure that the person who signs the child out shall use his/her full legal signature and shall record the time of day. The main sign out will be inside the classroom. Indoor Activity Space Based on the measurements obtained, the indoor space allows the requested capacity of 50 children. LPA observed furniture and equipment to be in good condition, free of sharp, loose, or pointed parts. Children’s bathrooms are located next to the library room. There are a total of (17) toilets and (19) sinks and (10) urinals located in the bathroom areas which is sufficient for the 50 children as requested. There is dispensable soap and paper towels in the bathrooms. The staff bathroom is located on the opposite side of the children's restrooms. Isolation area if needed is located in the main office of the elementary school site.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen Estrella	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FUTURE FIRST AFTERSCHOOL PROGRAM	FACILITY NUMBER: 197494143
	VISIT DATE: 07/12/2019

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
26
27
28
29
30
31
32

Licensee shall maintain Administrative Records which shall have the following:

Administrative Records
Written inspection procedures for accepting children on a daily basis.
Sign-out sheets kept for current 30 days; or to use of electronic pin system.

Admission policies, including admission criteria, ages of children who will be accepted; medical assessment requirements; program activities, supplemental services, if any; field trip provisions, transportation arrangements, food service, if any.
Designation of Facility Responsibility (LIC 308).
Personnel Report (LIC 500) showing current roster.
Licensee affidavit regarding persons exempt from fingerprint requirements (Use back of LIC 500).
Emergency Disaster Plan (LIC 610) (a posting requirement; see below) with verification that disaster drills are conducted every six months. Documentation of drills shall be maintained for at least one year.Up-to-date list of qualified teacher substitutes.
Documentation of exceptions and waivers: Facility Waiver Request (LIC 956) and Exception/Exemption Request (LIC 971).
Annual licensing reports and substantiated complaints from the last three years (must be available at the center for public review). and a Child Care Facility Roster (LIC 9040).

The applicant was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541.Email Address: childcareadvocatesprogram@dss.ca.gov.

Based on todays inspection the facility shall be recommended for licensure pending management approval. An exit interview was conducted and a copy of this report was provided to Obaid Yousufzai, applicant.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen Estrella	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FUTURE FIRST AFTERSCHOOL PROGRAM	FACILITY NUMBER: 197494143
	VISIT DATE: 07/12/2019

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
26
27
28
29
30
31
32

Overhead lighting provides the majority of the light in the classrooms, but sunlight comes through doors and windows. Storage hooks for located outside each classroom for all children's belongings. LPA observed drinking water available for the children as well.

Outdoor Activity Space
Based on the measurements obtained, the outdoor space allows the requested capacity of 50 children. Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Per the applicant, the children in care will be bringing their own water bottles and drinking water will be available for children when outside in the yard.

Medication/First Aid Kits/Snacks
Applicant states the facility will not be administering medication and students will be sent to the main office to the nurse office. At this time, the facility does not provide Incidental Medical Services (IMS). Applicant was advised that children should be screened every afternoon for illness and unusual marks. First Aid supplies are stored in the classroom and in the general adult areas. The facility will provide PM snacks. All food shall be protected against contamination, advised to always place open food items in zip lock bags or plastic containers. LPA observed all storage containers for solid waste, it was advised that moveable bins have tight-fitting covers and that they are kept on, and in good repair. LPA observed all areas that are accessible to the children were toxic free and director was advised to take measures to keep the facility free of flies, other insects and rodents.

The following was discussed with the applicant:
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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: http://www.ada.gov/childqanda.html.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen Estrella	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FUTURE FIRST AFTERSCHOOL PROGRAM	FACILITY NUMBER: 197494143
	VISIT DATE: 07/12/2019

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
26
27
28
29
30
31
32

Required Postings/Licensee shall have posted in the Child Care Center at all times the following:
Facility license.
Personal Rights form (LIC 613A).
Menus.
Child passenger restraint system poster. (PUB 269).
Daily activity schedule.
Emergency Disaster Plan (LIC 610) and Earthquake Preparedness Checklist (LIC 9148).
Parent’s Rights Poster (PUB 393).
Notice of Site Visit (LIC 9213).
Any licensing report documenting a type”A” citation must be posted for 30 days. Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type A deficiency must be posted for 30 days.

Employee/Volunteer Files shall also be maintained and shall contain the following:
Health Screening Report - Facility Personnel (LIC 503) and TB Clearance.
Proof of Immunizations
Mandated Reporter Training Certificate of Completion. www.mandatedreporterca.com
TB Clearance and "Good Health" statement from volunteers.
Personnel Record (LIC 501) or application/resume.
Evaluation of Director Qualifications (LIC 9096).
Evaluation of Teacher Qualifications (LIC 9095).

For each aide under age 18, verification of high school graduation or current participation in an occupational program conducted by an accredited high school or college. Criminal Record Statement (LIC 508) for staff subject to fingerprint requirements. Fingerprint clearances - Proof of clearance (Criminal Record, FBI and Child Abuse).

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen Estrella	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4