197494316-2-4-2022-30-CC-MRUZ-CBHQHQ-20220210111130

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197494316
Report Date: 11/19/2021
Date Signed: 02/04/2022 11:58:23 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2021 and conducted by Evaluator Lisa Clayton

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20211116132952

FACILITY NAME:	FUTURE STARS ACADEMY		FACILITY NUMBER:	197494316
ADMINISTRATOR:	OLSHANSKY, IRENE		FACILITY TYPE:	850
ADDRESS:	4946-50 W 20TH& 5005 W 21ST ST		TELEPHONE:	(323) 937-7827
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90016
CAPACITY:	116	CENSUS: 44	DATE:	11/19/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	IRENE OLSHANKSY, LICENSEE		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Personal Rights
Personal Rights

INVESTIGATION FINDINGS:

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On 11/19/21, Licensing Program Analyst (LPA), Lisa Clayton, arrived at the above mentioned CCC to conduct an unannounced 10 day complaint investigation. Upon arrival LPA entered the 4950 building and walked through an empty class room and opened the door to another. LPA observed Teacher 1 and 7 children. LPA Clayton introduced myself and asked how to get to the office, Teacher 1 advised that the office was in the next building. I closed the door to her room and started to exit the first room when I heard the above mentioned teacher yelling at the children "NO, STOP IT, DON'T DO THAT". I opened the door and observed Teacher 1 holding a child by his arm and lifting him from a chair saying "let's go". I asked her does she always yell at the children like that and she responded that she was stopping him from hitting another child (still holding on to his arm), while walking around the table. The child attempted to sit on the floor, she then let go of his arm and picked him up.

Upon entering the office I was greeted by Director Eartha Daniels and Licensee Irene Olshansky. I informed them of what I just witnessed with the Teacher and that the door to the 4950 building was unlocked and Director Eartha left the room to go check on the unlocked door and to talk to Teacher 1. I explained the reason for the visit to the Licensee.

(continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

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

LIC9099 (FAS) - (06/04)

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Control Number 30-CC-20211116132952

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 11/19/2021

NARRATIVE

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The facility was toured both inside and outside with the Director for a Health and Safety inspection. LPA observed 11 teachers and 44 children in care.

The Director provided LPA Clayton a copy of the Children's Facility Roster of children that are currently enrolled. LPA instructed Licensee and/or Director to email a roster for the last 3 years to include the children's DOB, Parent contact information, date of enrollment and disenroll date, as well as Staff information to include name, telephone numbers, and working days & hours. Based on the information obtained the allegation requires further investigation.

Based on the observation in the Young 2's room with Teacher 1 and C1, the attached type B deficiency is cited today . Appeal rights were given & discussed. This report must be available for 3 years. An exit interview was conducted & a site visit notice posted adjacent to the main entry doorway for 30 days. Failure to do so will result in a $100 civil penalty fine.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 30-CC-20211116132952

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/19/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/19/2021 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.	1 2 3 4 5 6 7	Licensee will ensure that all Teachers and staff are aware of the discipline policy, Title 22 and Health and Safety Regulations and how to handle the children appropriately.
	8 9 10 11 12 13 14		8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

LIC9099 (FAS) - (06/04)

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