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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 053614375
Report Date: 11/21/2023
Date Signed: 11/22/2023 07:58:56 AM

Document Has Been Signed on 11/22/2023 07:58 AM - 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:STALCUP, MERLITAFACILITY NUMBER:
053614375
ADMINISTRATOR:MERLITA STALCUPFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 559-6922
CITY:COPPEROPOLISSTATE: CAZIP CODE:
95228
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 1DATE:
11/21/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Merlita and Calvin StalcupTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Corina Beckby met with Licensee, Merlita and husband Calvin Stalcup on 11/21/2023 for the purpose of an unannounced plan of correction inspection to clear all deficiencies, issued on 10/26/2023.

LPA observed Licensee and assistant caring for 1 preschool child during today's inspection. LPA toured the facility and found no deficiencies.



LPA observed 6 children's files. All files are complete and up to date.

LPA observed updated fire drill log and emergency disaster plan.

LPA also collected Vaccination records, Orientation Certificate and Preventative Health and Safety for Calvin Stalcup to become a co-licensee. As of today Calvin Stalcup will be listed as a co-licensee.

All deficiencies cited on 10/26/2023 are cleared effective today. Proof of correction letters were provided for the corrected deficiencies. LPA reviewed report with Licensees, Merlita and Calvin Stalcup. Appeal Rights were provided. A notice of site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
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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