393609647-9-29-2023-53-CC-ESIA-CW5PGG-20230929111820

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393609647
Report Date: 09/29/2023
Date Signed: 09/29/2023 11:18:27 AM

Document Has Been Signed on 09/29/2023 11:18 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:	GALLION, STACEY		FACILITY NUMBER:	393609647
ADMINISTRATOR:	GALLION, STACEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 476-8015
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	14	CENSUS: 9	DATE:	09/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	Stacey Gallion		TIME COMPLETED:	11:35 AM

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	On 09/29/23, Licensing Program Analyst (LPA) Elvira Sierra met with the licensee, Stacey Gallion for the purpose of an unannounced annual inspection. Form (LIC 126), Entrance Checklist for Family Child Care Homes, was provided to Licensee. Present in the facility was Licensee and Licensee’s Assistant caring for 9 children. Licensee's adult daughter was also present in the home. Licensee owns the home. Home is one story three bedroom and 1 ½ bathroom house. Licensee changed facility hours of operation to 06:00am to 05:30pm. A health and safety inspection was conducted in all areas accessible to children. Upon entry, LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Right. Off-limit areas are: Bedroom #1 (see facility sketch), the full bathroom, closet by the hallway, and the two storage sheds located in the backyard. Off-limits areas will remain inaccessible to children by closed doors, locks and/or supervision. The licensee acknowledges that she must contact LPA prior to making an off-limits area on-limits and vice versa and any new construction to the home. Hazardous items/cleaning supplies and knives are stored inaccessible to children. Licensee stated that there are no children enroll that required medical service. Licensee stated that personal medication is stored inaccessible to children and located in an upper cabinet in the kitchen. Functioning smoke/carbon monoxide detectors were observed in the home and meet Title 22 regulations. LPA observed a working 2-A-10-BC fire extinguisher. The license stated there are no weapons in the home. There is a fireplace in the living room cover with tempered glass. Licensee stated that the fireplace is not used. There are no bodies of water on the premises. Facility provides meals and transportation for clients. Fire drill was conducted last on 07/19/23 and is properly documented. One staff and five children’s files were reviewed and are completed. Preventative health and current pediatric CPR and first aid training was verified for Licensee’s Assistant and Licensee. Licensee CPR expires on 09/13/25. Licensee’s Mandated reporter training expires on 06/11/25. Licensee was advised that Mandated reporter Training must be completed once every two years, and training is accessible at www.mandatedreporterca.com Report continues subsequent page 809C---

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: GALLION, STACEY	FACILITY NUMBER: 393609647
	VISIT DATE: 09/29/2023

NARRATIVE

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All individuals subject to criminal background review have obtained a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licenses acknowledge that a Plan for Providing IMS must be submitted to the Department if provided. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

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

Licensee was made aware of the (LIC9227) Individual Infant Sleeping Plan, for infants under 12 months and sleep logs for all infants in care under 24 months need to be maintained in children’s files. LPA discussed and provided an example of a sleep log. --------Report continued on subsequent 809C...

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: GALLION, STACEY	FACILITY NUMBER: 393609647
	VISIT DATE: 09/29/2023

NARRATIVE

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee 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.

An exit interview was conducted. This report and Appeal of Rights were reviewed and provided to Licensee, Stacey Gallion. Notice of Site Visit posted and should remain posted for 30 days.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC809 (FAS) - (06/04)

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