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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494430
Report Date: 11/08/2023
Date Signed: 11/08/2023 12:01:16 PM

Document Has Been Signed on 11/08/2023 12:01 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHORT AVE ELEMENTARY SCHOOLFACILITY NUMBER:
197494430
ADMINISTRATOR:AMATO, VERONICAFACILITY TYPE:
840
ADDRESS:12814 MAXELLA AVETELEPHONE:
(310) 975-8524
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
11/08/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Jen Tubbs- RepresentativeTIME COMPLETED:
12:26 PM
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On 11/8/2023 Licensing Program Analyst (LPA) Jillinda Chandler made an announced visit to the Short elementary school campus for the purpose of conducting a Case Management – Licensee Initiated inspection. The licensee is requesting an increase in capacity for the Got Game Sports school-age, after school program. LPA met with Jen Tubbs- Compliance representative, who provided a tour of the room 17 and the schools auditorium, at the time of todays visit the licensee did not have a current agreement from Los Angeles Unified School District readily available for review. Per Ms. Tubbs the program was granted use of the schools auditorium as well as room 17.

LPA observed the auditorium, there were auditorium style seats and a stage. LPA observed two non-gender identified restroom, per plant manager (Raul)


the restroom on the east side of the auditorium was under construction with an estimated time of completion to be the end of 2023. Children also have access to restrooms located near the play ground.

LPA observed two exit door with push handles that lead outdoor to the two main cross streets (Maxella and Moore street) licensee shall devise a plan to ensure that staff is aware if a child should exit theses doors. LPA strongly recommends that a sort of alerting mechanism be added to the exits. pg. 1
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHORT AVE ELEMENTARY SCHOOL
FACILITY NUMBER: 197494430
VISIT DATE: 11/08/2023
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Fire extinguishers were observed in the auditorium last inspected 5/16/2023, LPA did not observe a fire extinguisher in room 17. there were trash cans with tight fitting lids, adequate lighting, heat and cooling.

The outdoors play area was gated,LPA did not observe any hazardous conditions in this area during today visit.

Per the posted occupancy plague the auditorium can accommodate 307 persons for assembly and 113 for dining. There was approximately 951.4 open square footage, minus the stage and the auditorium seating. LPA advise the licensee Mr. Kalman to provide an operating plan for the increased capacity.
There is an approved fire clearance on file conducted by Inspector Mann of the Los Angeles City Fire Department.

Based on Health and Safety Code Sections 1596.806(b), (b)(1) and (d) state:
(b) School grounds, other than rooms used as classrooms, used by a schoolage child care program operated on a functioning schoolsite pursuant to either paragraph (1) or (2) of subdivision (a) shall be exempt from all of the following requirements imposed by the department on child day care facilities:
(1) Fencing, outdoor activity space, toilet, and isolation space requirements.

Licensee was informed that the use of these spaces shall be used at the same intended capacity as when being used by the school district.
pg. 2
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHORT AVE ELEMENTARY SCHOOL
FACILITY NUMBER: 197494430
VISIT DATE: 11/08/2023
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The program shall be recommended for an increase from 40 to 100 pending management review, correction and operation agreement between Los Angeles Unified School District and the licensee.

An exit interview was conducted, a copy of this report was discussed and provided to Jen Tubbs - representative.












pg. 3
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3