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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 053614375
Report Date: 09/29/2022
Date Signed: 09/29/2022 04:02:30 PM

Document Has Been Signed on 09/29/2022 04:02 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:STALCUP, MERLITAFACILITY NUMBER:
053614375
ADMINISTRATOR:MERLITA STALCUPFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 785-2657
CITY:COPPEROPOLISSTATE: CAZIP CODE:
95228
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
09/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Merlita StalcupTIME COMPLETED:
04:30 PM
NARRATIVE
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On Thursday, September 29, 2022, Licensing Program Analysts (LPAs) Elvira Sierra and Tiffanie Diep conducted a Case Management inspection and met with Licensee Merlita Stalcup. LPA observed there were currently three children in care with the Licensee.

LPAs learned through interviews that Licensee's adult daughter (A1) helps Licensee occasionally with the daycare children. Licensee stated that her daughter, Angelica Stalcup does not live in the home however she helps sometimes with the daycare children. LPAs advised that all adults living or working in the home over the age of 18 must be fingerprint cleared. During today's inspection LPAs also observed a baby excersaucer , a baby walker and a bouncer in the home accessible to the children. License stated that she was unaware that such a items were not allowed in the daycare.

Deficiencies were cited on subsequent page 809D. Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, Licensee shall post LIC 809 D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. Exit interview was conducted. LIC 9224 and Appeal Rights were reviewed and provided to Licensee, Merlita Stalcup.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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 09/29/2022 04:02 PM - It Cannot Be Edited


Created By: Elvira Sierra On 09/29/2022 at 03:46 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: STALCUP, MERLITA
FACILITY NUMBER: 053614375

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/30/2022
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department.

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Licensee stated that she understand that A1 must be fingerprint clear before helping with the children. LPA received a written statement that A1 won't be helping with the kids. Licensee will ask A1 to obtain fingerprints.
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This requirement was not met as evidence by;
Licensee admitted to have her adult unfingerprinted daughter (A1)helping with the care and supervision of the daycare children ocassionally.This is a requirements that if not corrected poses an immediate risk to the health and safety of the children in care.
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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:Bettina Engelman
LICENSING EVALUATOR NAME:Elvira Sierra
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/29/2022 04:02 PM - It Cannot Be Edited


Created By: Elvira Sierra On 09/29/2022 at 03:49 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: STALCUP, MERLITA
FACILITY NUMBER: 053614375

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited
CCR
1596.846(b)(c)

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ยง1596.846 (b)(c) Baby walkers
(b) A baby walker shall not be kept or used on the premises of a child day care facility.
(c) A "baby walker" means any article described in paragraph (4) of subdivision (a) of Section 1500.86 of Part 1500 of Title 16 of the Code of Federal Regulations.
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Licensee removed items during today's inspection. Deficiency cleared and corrected on today's inspection.
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This requirement was not met as evidence by; LPAs observed a baby bouncer, a baby walker and a exersaucer in the daycare areas. This is a requirement that if not corrected can pose a risk to the health and safety of the children in care.

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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:Bettina Engelman
LICENSING EVALUATOR NAME:Elvira Sierra
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022


LIC809 (FAS) - (06/04)
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