<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093623159
Report Date: 01/22/2020
Date Signed: 01/22/2020 02:37:46 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 ACADEMYFACILITY NUMBER:
093623159
ADMINISTRATOR:COLABROY,KIMBERLYFACILITY TYPE:
830
ADDRESS:2249 HELEN AVENUETELEPHONE:
(530) 541-5411
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY:8CENSUS: 7DATE:
01/22/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Holly ShamasTIME COMPLETED:
03:05 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),Michelle Pascual and Licensing Program Management (LPM) Bettina Engelman met with director Holly Shamas for an unannounced case management visit of the infant center. The purpose of the visit was to inspect the newly installed barrier between infant sleeping and activity areas. The facility has been operating on a Provisional License pending completion of a barrier that meets regulations. Upon inspection there were 7 children and 2 staff present. The facility's hours of operation are Monday- Friday, 8:00am- 5:00pm.

LPA and LPM toured the facility, including the crib and activity areas. Since the last inspection, licensee has installed an additional plexiglass panel that connects the previously installed panel to the wall. The changing table was moved further away from the bathroom and still within an arm's reach length away from the sink to provide an additional barrier between crib and activity space. The opening between the plexiglass panels and changing table was measured at 2 feet and 5 inches.

LPA and LPM discussed with staff to continue to provide adequate supervision of infants while they are sleeping in the crib area. Safe sleep practices were also reviewed.

An exit interview was conduct and a Notice of Site Visit was posted. In the areas that were evaluated today, no deficiencies were cited.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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 1