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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500546
Report Date: 02/16/2023
Date Signed: 02/16/2023 02:43:09 PM

Document Has Been Signed on 02/16/2023 02:43 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:GULLEY, PORSCHA & GULLEY-SMITH, HEAVENFACILITY NUMBER:
394500546
ADMINISTRATOR:GULLEY, PORSCHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(401) 649-1246
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Porsha Gulley and Heaven Gulley-SmithTIME COMPLETED:
03:15 PM
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On February 16th, 2023, Licensing Program Analysts (LPAs) Corina Beckby and Elvira Sierra conducted an unannounced annual inspection visit and met with Licensee Porscha Gulley. Licensee Heaven Gulley-Smith arrived later during the inspection. Facility hours of operation are 24 hours seven day a week. Licensees were advised never to exceed 24 hours of consecutive care.

A review of the Facility Personnel Summary shows that all adults living and working in the home have criminal record clearances on file with Licensing. Licensee stated that no new residents have moved into the home since licensure. Capacity specified on the license was met during today’s inspection. Present in the facility were licensee and oldest daughter, caring for four children (3 infants, one preschool). One infant was Licensee, Porscha Gulley own child. LPAs discussed annual fees with Ms. Gulley. Annual fees are up to date.

Licensees were 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.

A health and safety inspection was conducted in all areas accessible to children. Upon entry, LPAs observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. LPAs also observed a current roster and confirmed fire drills are conducted at least once every six months. Current in person EMSA CPR and First Aid certification for Licensee, Porscha Gulley was verified and expires on 10/2023. and Ms. Heaven expires on 06/14/23.



Mandated Reporter Training is expired and LPAs discussed the requirement to renew the mandated reporter training every two years and provided the Mandated Reporter training website: www.mandatedreporterca.gov.

Report continues on LIC809-C.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: GULLEY, PORSCHA & GULLEY-SMITH, HEAVEN
FACILITY NUMBER: 394500546
VISIT DATE: 02/16/2023
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The facility maintains a working phone, 3A40BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Hazardous and personal hygiene items are inaccessible to children in care. Sharp utensils are stored in the pantry closet in the top shelf, drawer secured with safety locks. Licensee stated there are no weapons in the home. The outdoor play space is fenced for supervision and is free of any hazards. The Off-limit areas are: entire upstairs, downstairs bedroom, casita, and the garage. Licensees acknowledged that children are never allowed in any off-limit areas, and that off-limit areas will remain inaccessible by locked doors, gates and supervision.

Four children files were reviewed. All required forms for the children in care are complete and maintained in the files. Licensee currently does not have any children enrolled that require IMS. If in the future any IMS is provided, Licensee acknowledges that a Plan for Providing IMS must be submitted to the Department.

LPA observed copies of the LIC9227 Individual Sleeping Plan, for infants in care under 12 months and sleep logs for all infants in care under 24 months. LPA discussed the safe sleep regulations with Licensee and provided 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.

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 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. LPA also encouraged Licensee to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.
Report continues on LIC809-C.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
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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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: GULLEY, PORSCHA & GULLEY-SMITH, HEAVEN
FACILITY NUMBER: 394500546
VISIT DATE: 02/16/2023
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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 [email protected]. 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.


Deficiency cited on subsequent page 809D. An Exit interview conducted, and the report was reviewed with Licensee. LPA posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a 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: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/16/2023 02:43 PM - It Cannot Be Edited


Created By: Corina Beckby On 02/16/2023 at 02:12 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: GULLEY, PORSCHA & GULLEY-SMITH, HEAVEN
FACILITY NUMBER: 394500546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 2 persons which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/16/2023
Plan of Correction
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Licensee and co-licnesee will take madnated reporter trainng by 2/20/23 and email LPA Beckby with the cetrificates.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Corina Beckby
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023


LIC809 (FAS) - (06/04)
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