343600372-2-28-2024-53-CC-KGUA-D3CKPF-20240314080437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343600372
Report Date: 02/28/2024
Date Signed: 02/28/2024 11:36:19 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2024 and conducted by Evaluator Katy Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20240209144231

FACILITY NAME:	MERRYHILL SCHOOL - LAGUNA PARK		FACILITY NUMBER:	343600372
ADMINISTRATOR:	KARINA MEDINA		FACILITY TYPE:	850
ADDRESS:	6613 LAGUNA PARK DRIVE		TELEPHONE:	(916) 684-4044
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	116	CENSUS: 102	DATE:	02/28/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Karina Medina		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not prevent day-care child from causing injuries to another child in care.

INVESTIGATION FINDINGS:

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On 02/28/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted an unannounced complaint investigation to deliver the findings for the above allegation. LPA met with Principal Karina Medina (P1). Throughout the course of the investigation, LPA conducted physical plant inspections, interviews, and reviewed and collected documentation. It was alleged that staff did not prevent a day-care child from causing injuries to another child in care. Interviews revealed that the teachers who were present on 02/08/2024, could not account for what had occurred to cause scratches and a bruise on a child in care. Therefore, a lack of supervision occurred.
Based on interviews and file reviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A Type-A deficiency was cited on a subsequent 9099-D page.

CONTINUED ON 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy Velazquez	TELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 53-CC-20240209144231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: MERRYHILL SCHOOL - LAGUNA PARK	FACILITY NUMBER: 343600372
	VISIT DATE: 02/28/2024

NARRATIVE

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P1 acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. An exit interview was conducted, and the report was reviewed with Principal Medina. LPA provided Licensee Appeal Rights to P1. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy Velazquez	TELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 53-CC-20240209144231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: MERRYHILL SCHOOL - LAGUNA PARK	FACILITY NUMBER: 343600372
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/28/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/29/2024 Section Cited CCR 101229(a)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.	1 2 3 4 5 6 7	All staff members who work in the Beginners Classroom will receive training on supervision which will include the CDSS.ca.gov video, "Supervising Children in Childcare Centers." An attendance log for the training, with staff signatures, will be emailed to LPA by 5 PM on 02/29/2024.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews and record review, the Licensee did not provide 100 percent visual observation of a daycare child on 02/08/2024 which poses/posed an an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy Velazquez	TELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

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