197494316-12-5-2019-30-CC-JESA-BJKSCT-20191205124604

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494316
Report Date: 12/05/2019
Date Signed: 12/05/2019 12:47:45 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 STARS ACADEMY		FACILITY NUMBER:	197494316
ADMINISTRATOR:	OLSHANSKY, IRENE		FACILITY TYPE:	850
ADDRESS:	4946 W. 20TH STREET		TELEPHONE:	(323) 938-5995
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90016
CAPACITY:	30	CENSUS: 0	DATE:	12/05/2019
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	E. Irene Olshansky and Marina Olshansky		TIME COMPLETED:	01:00 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 12/05/19 Licensing Program Analysts (LPA's) Jeanette Estrada, Dalicia Adkins, Antonio Almanza, Claudia Escobedo, and Stella Gutierrez conducted an in-person meeting with Directors, E. Irene Olshansky and Marina Olshansky for the purpose of reviewing requested documentation on NOI 184C for facilities 197494289 (Preschool with toddler option license), 197494316 (Preschool license) , 197494317(Infant license) and 197494318 (Preschool license). LPAs, Estrada, Adkins, Almanza, Gutierrez and Escobedo discussed the following during today’s visit with the Directors. Documents listed on 184C need update to move forward with application process. Items that are required to be updated are, Application (LIC200A), Applicant information (LIC 215), Administrative Organization (LIC309), Monthly Operating Statement (LIC 401), Financial Information Release and Verification (LIC 404), Personnel Report (LIC 500), Personnel Record (LIC 501), Health Screen reports -Facility Personnel (LIC 503), Emergency Disaster Plan (LIC 610), Facility Sketch (Floor Plan) (LIC 999) PG.1

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FUTURE STARS ACADEMY	FACILITY NUMBER: 197494316
	VISIT DATE: 12/05/2019

NARRATIVE

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The following items were received during today’s meeting:
· For 197494318-LIC200A-Application for Child Care Center License, LIC 309-Administrative Organization, LIC 401-Monthly Operating Statement, LIC 404-Financial Information Release and Verification, LIC 9096-Evaluation of Director Qualifications, LIC 503-Health Screening Report-Facility Personnel (E. Irene Olshansky & Marina Olshansky), CPR AED First Aid Certification (E. Olshansky), LIC 610-Emergency Disaster Plan for Child Care Centers, LIC 999-Facility Sketch (Floor Plan and Yard), Tenant Lease and Campus-Wide Preschool Playground Waiver Request.
· For 197494289-LIC 309-Administrative Organization, LIC 401-Monthly Operating Statement, LIC 404-Financial Information Release and Verification, LIC 503-Health Screening Report-Facility Personnel (E. Irene Olshansky & Marina Olshansky), Childcare Health & Safety Certification (Marina Olshansky), CPR AED First Aid Certification (Marina Olshansky), LIC 610-Emergency Disaster Plan for Child Care Centers, LIC 999-Facility Sketch (Floor Plan and Yard), Tenant Lease and Campus-Wide Preschool Playground Waiver Request.
· For 197494317-LIC 309-Administrative Organization, LIC 404-Financial Information Release and Verification, LIC 501 Personnel Record (Sara Poage), LIC 503-Health Screening Report-Facility Personnel (E. Irene Olshansky & Marina Olshansky), Childcare Health and Safety Certification (Sara Poage & Marina Olshansky), LIC 610-Emergency Disaster Plan for Child Care Centers, LIC 999-Facility Sketch (Floor Plan and Yard), Tenant Lease and Campus-Wide Preschool Playground Waiver Request.
· For 197494316 (Preschool license)- LIC 309-Administrative Organization, LIC 401-Monthly Operating Statement, LIC 404-Financial Information Release and Verification, LIC 501 Personnel Record (Sara Poage), LIC 503-Health Screening Report-Facility Personnel (E. Irene Olshansky & Marina Olshansky), Childcare Health & Safety Certification (Sara Poage), LIC 610-Emergency Disaster Plan for Child Care Centers, LIC 999-Facility Sketch (Floor Plan and Yard), Tenant Lease and Campus-Wide Preschool Playground Waiver Request.

PG. 2

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FUTURE STARS ACADEMY	FACILITY NUMBER: 197494316
	VISIT DATE: 12/05/2019

NARRATIVE

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The following items are still pending and are requested by due date of 12/19/2019
· For 197494318-LIC 215-Applicant Information (E. Irene Olshansky & Marina Olshansky), LIC 500 Personnel Report, LIC 501 Personnel Record (E. Irene Olshansky), LIC 9096 (Irene Olshansky), Parent Handbook, Fire Clearance and Employee Handbook
· For 197494289-LIC 200A Application for a Child Care Center License, LIC 215-Applicant Information (E. Irene Olshansky & Marina Olshansky), LIC 500 Personnel Report, LIC 501 Personnel Record (Marina Olshansky), LIC 9096 Evaluation of Director (Marina Olshansky), Parent Handbook and Employee Handbook
· For 197494317-LIC 200A Application for a Child Care Center License, LIC 215-Applicant Information (E. Irene Olshansky & Marina Olshansky), LIC 401 Monthly Operating Statement, LIC 500 Personnel Report, LIC 9096 Evaluation of Director (Sara Poage), Parent Handbook and Employee Handbook
· For 197494316-LIC 200A Application for a Child Care Center License, LIC 215-Applicant Information (E. Irene Olshansky & Marina Olshansky), LIC 500 Personnel Report, LIC 9096 Evaluation of Director (Sara Poage), Parent Handbook and Employee Handbook

An exit interview was conducted and copy of this report was provided.

PG. 3

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

LIC809 (FAS) - (06/04)

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