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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313619587
Report Date: 10/16/2023
Date Signed: 10/16/2023 12:53:48 PM


Document Has Been Signed on 10/16/2023 12:53 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:MERRYHILL SCHOOL - FOOTHILLSFACILITY NUMBER:
313619587
ADMINISTRATOR:NATASA ZIVKOVICFACILITY TYPE:
830
ADDRESS:3989 FOOTHILLS BOULEVARDTELEPHONE:
(916) 782-2500
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:24CENSUS: 12DATE:
10/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Natasa Zivkovic - Preschool PrincipalTIME COMPLETED:
01:30 PM
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An unannounced annual/random inspection on the Infant Program is made today by Licensing Program Analysts Owens and McClain. LPA Owens and McClain met with Natasa Zivkovic, Preschool Principal. Present at time of inspection were 12 infants and 3 staff.

A tour of the infant classrooms were conducted. The following areas are in compliance during inspection: There are no bodies of water. Firearms and ammunition are not on the premises. Storage area for poisons is locked. Disinfectants, hazardous items and medications are inaccessible to children. Fire drills are conducted according to Title - 22 Regulations. The infant indoor and outdoor activity space is physically separate from the space used by other day care children. Infant furniture and equipment, including cribs, cots/mats, and feeding chairs are sufficient, age appropriate and in good repair. Infant changing tables have padded surface no less than one inch thick, covered with washable vinyl or plastic, and have raised sides at least three inches high. Toys appear to be safe, without sharp points, edges, splinters or small parts that can be pulled off and swallowed.
Facility is in compliance with staff infant ratios. All infants including those napping in cribs are under visual observation at all times. Feeding plans and sleeping log reviewed for some infants, Needs and Services plans reviewed for some infants. Facility uses an electronic sign in / out system for parents; this is being used according to the waiver on file. Staff utilized as infant teachers have three child development units in infant/toddler care.

No excluded individuals are present. Natasa Zivkovic was reminded that all adults 18 and over, 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 Child Care Center. 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. Staff subject to a criminal record clearance or exemption are associated to the facility. Continued on next page.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2023
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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MERRYHILL SCHOOL - FOOTHILLS
FACILITY NUMBER: 313619587
VISIT DATE: 10/16/2023
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First Aid/CPR reviewed and in compliance. Emergency information reviewed for some infants. Staff records reviewed contain documentation of the educational background, training, and/or experience. Operating hours are Monday thru Friday; 6:30 AM to 6:00 PM.

LPA observed proof that all staff/ volunteers have met the requirements of SB 792. LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com

Facility is in compliance with Assembly Bill 2370, which required licensed Child Care facilities to test their water for excessive amounts of lead. Testing was completed on 7/8/2022. Facility understands that the lead testing must be conducted every five years from initial testing.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.



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

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Continued on next page.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023
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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MERRYHILL SCHOOL - FOOTHILLS
FACILITY NUMBER: 313619587
VISIT DATE: 10/16/2023
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No deficiencies observed in the areas inspected during today's inspection. This report was reviewed and discussed with the facility representative at the time of the inspection.

A COPY OF THIS REPORT MUST REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
NOTICE OF SITE VISIT FORM POSTED TO PARENT'S BOARD FOR 30 DAYS.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023
LIC809 (FAS) - (06/04)
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