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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500515
Report Date: 11/30/2023
Date Signed: 11/30/2023 02:55:37 PM

Document Has Been Signed on 11/30/2023 02:55 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GILLUM, DENISHAFACILITY NUMBER:
394500515
ADMINISTRATOR:GILLUM, DENISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 955-9942
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
11/30/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Denisha GillumTIME COMPLETED:
03:15 PM
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On 11/30/23, Licensing Program Analyst (LPA) Elvira Sierra met with the licensee, Denisha Gillum for the purpose of an unannounced annual inspection. Form (LIC 126), Entrance Checklist for Family Child Care Homes, was provided to Licensee. All individuals subject to criminal background review have obtained a criminal record clearance verified by LPA accessing Guardian. Licensee stated there are no new residents living in the home since licensure. Present in the facility was Licensee and her assistant caring for 4 children. One child is Licensee own. Licensee's husband was also present during the inspection. Licensee owns the home. Home is one story three bedroom and two bathroom house. Facility hours of operation are 7 days a week 24 hours a day. Applicant understands not to exceed 24 hours of consecutive care.

A health and safety inspection was conducted in all areas accessible to children. LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Right. Off-limit areas are: Bedroom # 2 or master bedroom bathroom # 2 (inside master bedroom), and garage. Licensee is requesting to make Bedroom #1 off limits. Bedroom # 1 is off limits to the daycare children after today's inspection. Areas remain inaccessible to children by closed doors, locks and/or supervision. Hazardous items/cleaning supplies are stored inaccessible to children by using cabinets child proof locks. Licensee was advised that child proof locks must always be in good working condition. Licensee stated there are no children that required medication at this time. 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. Licensee stated there are no weapons in the home and no bodies of water were observed. There is a fireplace in the living room that is properly barricaded. Facility provides meals to the children and facility is enrolled with the Child Care Food Program (CACFP) Family Resource Center. Fire drills are conducted at least once every six months and are properly logged.
Three children files were reviewed and one staff file. CPR/First Aid (expires 10/21/25). Mandated Reporter Training expires on 09/24/25. 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---
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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: GILLUM, DENISHA
FACILITY NUMBER: 394500515
VISIT DATE: 11/30/2023
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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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/. PIN 22-02-CCP was provided to the Licensee during today's inspection.

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...
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
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: GILLUM, DENISHA
FACILITY NUMBER: 394500515
VISIT DATE: 11/30/2023
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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, Denisha Gillum. Notice of Site Visit posted and should remain posted for 30 days.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
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