313623339-11-26-2019-03-CC-SDLA-BJAV2Q-20191126150331

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623339
Report Date: 11/26/2019
Date Signed: 11/26/2019 03:03:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	MERRYHILL SCHOOL-ROCKLIN		FACILITY NUMBER:	313623339
ADMINISTRATOR:	SUE STEWART		FACILITY TYPE:	830
ADDRESS:	5893 STANFORD RANCH RD		TELEPHONE:	(916) 624-4511
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	40	CENSUS: 0	DATE:	11/26/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Marriah Pearson and Sue Stewart		TIME COMPLETED:	03:15 PM

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	Application Specialist (AS) Seychelle De Luca and Licensing Program Analyst (LPA) Marea Behvand met with Applicant Marriah Pearson and Director Sue Stewart for the purpose of an announced prelicensing change of location inspection. The facility is currently licensed under facility number 310321428. Applicant requests an infant license to serve 40 infant children from 0-24 months of age. The program will operate Monday through Friday from 6:30 AM to 6:00 PM. During today's inspection, Applicant filled out a new application, requesting 18 infant children. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. AS and LPA discussed the forms that must be in each child's and each staff member's file and AS provided LIC311A, Safe Sleep in Child Care, Effects of Lead Exposure brochure, and new immunization card. Applicant stated the Needs and Services plans will be kept in the classroom. The facility will provide dry snacks. Parents will provide formula, breast milk, and baby food for their children. INDOOR ACTIVITY SPACE: There is one infant classroom. AS and LPA observed a sufficient amount of tables, chairs, high chairs, and cubbies. Director stated they will move the cribs over from the currently licensed location by the time AS returns. Applicant stated a first aid kit will be in each classroom and medications will be stored in each classroom. Applicant stated there are no poisons or firearms on the premises. Applicant stated the facility will use an electronic sign-in/sign-out system. Applicant stated there are no poisons or firearms on the premises. Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MERRYHILL SCHOOL-ROCKLIN	FACILITY NUMBER: 313623339
	VISIT DATE: 11/26/2019

NARRATIVE

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AS and LPA measured one classroom. The total classroom space contains a total of 641.1585 square feet, which will accommodate Applicant's request for 18 infant children. There are 12 toilets and 20 sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the parlor and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one infant outdoor area, infant/toddler yard, on the property. This yard is separated from the preschool yards with a chain link fence. Outdoor play areas will be fenced with a wrought iron fence that is at least four feet tall. During today's inspection, AS and LPA observed some sections of fence have not been installed. There are no bodies of water on the premises. There are shaded areas supplied by canopies and overhangs. The outdoor play area is fenced that is at least four feet tall. AS and LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises.

AS and LPA measured the outdoor activity space. The outdoor play area contains a total of 3653.515 square feet, which accommodates Applicant's updated request for 18 infants. Applicant will provide a waiver request for infants and toddlers in the toddler option to share the play space. Applicant acknowledges infants and toddlers may not use the space at the same time and will provided schedules to AS. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Incidental Medical Services and a Plan of Operation is located in the facility file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/(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.

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MERRYHILL SCHOOL-ROCKLIN	FACILITY NUMBER: 313623339
	VISIT DATE: 11/26/2019

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AS and LPA discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS and LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

This facility evaluation report was reviewed and discussed with Applicant. Applicant were encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

The following items are required prior to final approval of license:

1. Fire clearance.

2. Applicant will submit an updated sketch, waiver requests, and Incidental Medical Services Plan of Operation.

3. AS De Luca will return once the facility is completely set up. AS will ensure changing tables have arrived, facility has a functional carbon monoxide detector, disinfectants and cleaning solutions are inaccessible and appropriately stored, water pitcher and cups are in each classroom, proof one more toilet has been installed and outdoor fence is completed.

4. LPM Keven Peters’ final file review.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

LIC809 (FAS) - (06/04)

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