093623159-8-8-2019-03-CC-ESIA-BEV3DD-20190808180923

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093623159
Report Date: 08/08/2019
Date Signed: 08/08/2019 06:09:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	JUBILEE KIDS ACADEMY		FACILITY NUMBER:	093623159
ADMINISTRATOR:	SHAMAS, HOLLY		FACILITY TYPE:	830
ADDRESS:	2249 HELEN AVENUE		TELEPHONE:	(530) 541-5411
CITY:	SOUTH LAKE TAHOE	STATE: CA	ZIP CODE:	96150
CAPACITY:	8	CENSUS: 0	DATE:	08/08/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Holly Shamas		TIME COMPLETED:	03:00 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	Licensing Program Analysts (LPAs) Elvira Sierra and Aruna Sridharan conducted a site inspection for the purpose of a prelicensing evaluation. LPAs met with applicant Holly Shamas. The facility is requesting an infant license with a capacity of 8 infants, the facility already has a preschool license. Parents Rights, Personal Rights, Car Seat Law, Emergency Disaster Plan, Earthquake Checklist, and facility Menu were posted. The facility will operate Monday-Friday from 6:30am-05:30pm. LPAs reviewed all required record with the applicant that the facility must maintain for all of the children, staff and volunteers. LPAs advised applicant that the Infants Needs and Service Plan must be updated quarterly. LPAs advised applicants that anyone working in the facility must obtain a criminal record clearance through Community Care Licensing. LPAs also discussed staffing qualifications and ratio/capacity regulations for an infant program with applicant. LPAs discussed Departments inspection authority regulations with the applicants and informed them that if any changes occur regarding the Designee/Director or an employee acting in their absence must be reported to Department within 10 working days. LPAs also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPAs advised applicants that if any unusual incidents occur they must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident. INDOOR ACTIVITY SPACE: The infant classroom (classroom #4 in the facility sketch) is not equipped with infant size furnishing, patty chairs or cribs at the moment. Applicant stated that she will obtained furnishing, sleeping equipment and age appropriate toys for the infant classroom Snacks will be prepared in the kitchen allocated in classroom # 5, food preparation area, equipment, dishes are sanitary and in good repair.The facility will provide AM/PM snack and the parents will provide any food for infants. Bottles will be brought from home, labeled, dated and returned daily. The facility will use a bottle warmer to warm the bottles. Report continued on page 2...

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: JUBILEE KIDS ACADEMY	FACILITY NUMBER: 093623159
	VISIT DATE: 08/08/2019

NARRATIVE

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LPAs advised applicant on Infant Napping Regulations and the requirement to have direct 100% supervision for sleeping infants. The activity classroom measure 265 square feet, which will accommodated the requested capacity of 8 infants. LPAs advised applicant on Safe Sleep practices and SIDS.

The applicant will use the office to isolate sick infants and the infants will be accompanied by a qualified staff. LPAs advised applicants on medication requirements and they are aware that all medications must be centrally stored. The facility has a locked box and fridge in classroom # 5 for medications. Incidental Medical Services (IMS) policy was discussed and facility has an incidental medical plan on file. 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.

OUTDOOR ACTIVITY SPACE: The facility is requesting a waiver for the infants to share the playground with the preschool license. The outdoor play area is fenced and is equipped with age-appropriate equipment. There is sufficient cushioning underneath climbing structures. There is shaded area covered by large trees. The outdoor activity space was measured and is 4180.44 square feet, which accommodates 56 children.
Department received fire clearance for 8 infants on June 3,2019.

License will be granted pending the following:

Infant classroom must be equipped with infant furnishing (cribs, patty chairs, infant play and equipment, changing table close to a sink that must be within arm length, etc)
Submit a waiver to share outdoor playground with preschool children.

Pending final approval by manager a license will be granted for a license of 8 infant children.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

LIC809 (FAS) - (06/04)

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