093623159-10-25-2019-03-CC-ESIA-BHAQM3-20191025121653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093623159
Report Date: 10/25/2019
Date Signed: 10/25/2019 12:17:18 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:	COLABROY,KIMBERLY		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:	10/25/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Holly Shamas		TIME COMPLETED:	12:15 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 Analyst (LPA) Elvira Sierra conducted a site visit for the purpose of a continuation prelicensing inspection. Licensing met with applicant Holly Shamas. Applicant already has a preschool license and is requesting an infant license for a capacity of 8 children. The facility has a copy of the following documents posted in a conspicuous area: Parent's Rights, Personal Rights, car seat law, earthquake preparedness checklist. INDOOR ACTIVITY SPACE: There is one room for the infants. The room is broken up with a separate play area and crib room divided by a four foot wall (panel) that is 4 foot in high and 4 feet 8 inches wide. Partition is not attached to a wall only to the ceiling. The crib room has four cribs and 4 mats. There is a changing table with a vinyl padded surface that is within arm's reach of a sink. There is a refrigerator to store food, milk, etc. that is brought from home. There is ample storage for children's belongings. Activity space has age appropriate furnishings, including toys and learning equipment. There is one bathroom with a toilet and a sink. All cleaning solutions are inaccessible to children. Infants who become ill during the day will be isolated in the office and will use the staff restroom if necessary. Isolation area has available playpen. Applicant understand isolation area shall be under constant visual observation by a director, an assistant director, a teacher or an aide. LPA remeasured the infant activity space due to the new installation of the 4-feet partition to separate the crib area from activity space. 21.4 X 13.2= 282.48- 13.94 (encumbered space) Total square footage is 268.54 which allows for 8 infants. 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: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

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: 10/25/2019

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OUTDOOR ACTIVITY SPACE;
Outdoor area was measured on previous inspection date 08/08/19 and is recorded on the Capacity worksheet (LIC 9024). Facility has enough outdoor space for the request capacity. Facility has a large outdoor area that will be shared with the preschool children. Facility requested a waiver for shared outdoor space on an alternating schedule with the preschool children.

Prior to issuing the license capacity for 8 children the following must be completed:

2) Pending upon receive Licensing Program Manager Approval.

This report was reviewed, and a copy was provided to Applicant.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

LIC809 (FAS) - (06/04)

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