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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343600372
Report Date: 01/24/2020
Date Signed: 01/24/2020 10:59:13 AM

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-LAGUNA PARKFACILITY NUMBER:
343600372
ADMINISTRATOR:NORRIS, LISAFACILITY TYPE:
850
ADDRESS:6613 LAGUNA PARK DRIVETELEPHONE:
(916) 684-4044
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:116CENSUS: 74DATE:
01/24/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Karina MedinaTIME COMPLETED:
11:07 AM
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Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted a case management inspection and met with Karina Medina, Director. There were 74 preschool children present at the facility.The purpose of today's inspection was to discuss an incident that had occurred on 7/28/19. LPA conducted interviews with children, collected documents, and observed the outside play area.

At this time no citations were given and an exit interview was conducted. A notice of cite visit was posted.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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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