093623159-12-10-2024-03-CC-SMAX-DBTSXU-20241210131632

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093623159
Report Date: 12/10/2024
Date Signed: 12/10/2024 01:16:44 PM

Document Has Been Signed on 12/10/2024 01:16 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	JUBILEE KIDS ACADEMY		FACILITY NUMBER:	093623159
ADMINISTRATOR/ DIRECTOR:	OYLER,KYLIE/SHAMAS,HOLLY		FACILITY TYPE:	830
ADDRESS:	2249 HELEN AVENUE		TELEPHONE:	(530) 541-5411
CITY:	SOUTH LAKE TAHOE	STATE: CA	ZIP CODE:	96150
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	12/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Kylie Oyler		TIME VISIT/ INSPECTION COMPLETED:	01:35 PM

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On 12/10/2024, Licensing Program Analyst (LPA) Soleil Marx, met with Facility Representative, Kylie Oyler, for an unannounced annual inspection. Facility hours of operation are Monday through Friday, 08:00 AM to 04:30 PM. LPA observed a census of six infants being supervised by two staff

LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items were inaccessible to children. The floors appeared clean throughout the facility. Furniture and equipment were in safe, operable condition. Outdoor activity space and equipment were in good repair and free of loose or sharp parts. LPA observed adequate cushioning in areas underneath climbing equipment and adequate shaded areas provided. Toileting facilities were in sanitary, and operating condition. Food preparation space was hygienic, and all food was protected against contamination. Infants bring milk and food from home. Uncontaminated drinking water was readily available to children both indoors and outdoors. Trash bins have tight-fitting lids. LPA observed an ample amount of first aid supplies available. LPA observed a carbon monoxide detector, smoke detector, and fully charged 2A10BC fire extinguisher within the facility. LPA observed authorized representatives are using full legal signatures on the sign in and out sheet. There are no bodies of water on the premises.

LPA observed a current Needs and Services plan for each infant and an Infant Sleeping Plan (LIC9227) for each child under 12 months of age. LPA observed sleep checks conducted and documented every 15 minutes for all children under two. LPA observed one crib or mat for each child in care with a tight fitted sheet. Staff stated that the bedding is changed daily. Infant diaper changing area is clean, within arm's reach of a sink, has raised sides, and contains a vinyl surface/mat that is at least one-inch-thick. Toys are of age-appropriate size, with no small parts. LPA observed labeled food and milk for infants, stored at safe temperatures. LPA observed staff documentation of feedings and diaper changes.

LPA observed infants utilizing recalled boppy loungers while under direct supervision of staff. Staff stated they were not aware of the recall and disposed of the recalled devices immediately once informed by LPA. LPA informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

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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Document Has Been Signed on 12/10/2024 01:16 PM - It Cannot Be Edited

Created By: Soleil Marx On 12/10/2024 at 12:14 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: JUBILEE KIDS ACADEMY	FACILITY NUMBER: 093623159
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101239(r)

Fixtures, Furniture, Equipment and Supplies

(r) Fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission shall not be used or on the facility’s premises. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by having recalled boppy loungers in the infant classroom, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/10/2024
	Plan of Correction
1 2 3 4	Facility disposed of boppy loungers immediately. Facility Representative will register infant devices for recall notifications. LPA cleared the POC during visit once recalled devices were removed off the premises.

Type B

Section Cited

CCR

101416.3(b)

Infant Care Aide Teacher Qualifications and Duties

(b) An infant care aide shall work under the direct supervision of the director, the assistant director or a fully qualified teacher, except as provided for in Section 101416.5(d)(1). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having a qualified infant teacher in the infant classroom while infants were awake, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/17/2024
	Plan of Correction
1 2 3 4	Facility Representative will create a break schedule to ensure there is always a fully qualified infant teacher present in the infant classroom while infants are awake. Facility Representative will send LPA Marx the break schedule by POC due date.

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:

Natalie Dunaway

LICENSING EVALUATOR NAME:

Soleil Marx

LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: JUBILEE KIDS ACADEMY	FACILITY NUMBER: 093623159
	VISIT DATE: 12/10/2024

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LPA reviewed facility records including child's records, personnel records, administrative records, and documents to be posted. LPA reviewed a sample of children’s files and observed that each child's file contained the required licensing documentation. LPA reviewed records for present staff. At least one staff member present today has current approved Pediatric CPR and First Aid certification. All staff currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, current AB1207 Mandated Reporter Training, and documentation of their educational background, training, and/or experience.

LPA observed an aide and teacher floater in the infant room supervising awake infants, while covering the fully qualified infant teachers 10 minute break. During record review of transcripts, LPA determined that during the ten minute break, neither staff had qualifying infant units. Staff stated they did not know an infant qualified teacher needed to be in the classroom to cover a short break when there are fully qualified infant teachers on the premises.

LPA observed a children's roster and fire drill log within the facility. Last fire drill was conducted 10/2024. LPA observed all required licensing documents were posted and visible to authorized representatives.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: JUBILEE KIDS ACADEMY	FACILITY NUMBER: 093623159
	VISIT DATE: 12/10/2024

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on today’s inspection, two type B deficiencies were cited on the 809-D page.

Exit interview conducted and report was reviewed with the Facility Representative. Appeal Rights provided. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

LIC809 (FAS) - (06/04)

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