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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603512
Report Date: 09/27/2019
Date Signed: 09/27/2019 09:33:54 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-CALVINEFACILITY NUMBER:
343603512
ADMINISTRATOR:GATBONTON, NIEVAFACILITY TYPE:
830
ADDRESS:9036 CALVINE ROADTELEPHONE:
(916) 689-7322
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:28CENSUS: 7DATE:
09/27/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
06:30 AM
MET WITH:Robin Kemmer, Assistant DirectorTIME COMPLETED:
09:40 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Mai Lor and Christopher Bello conducted an unannounced annual random inspection for the infant program. LPAs met with Assistant Director Robin Kemmer. A tour of the infant area was conducted. LPAs observed seven infants supervised by three staff. Operating hours are Monday through Friday; 6:30 AM to 6:00 PM.

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 are safe, without sharp points, edges, splinters or small parts that can be pulled off and swallowed. Facility is in compliance with staff infant ratios. Electronic sign in/sign out have full legal signature and record of time of day. Staff utilized as infant teachers have three child development units in infant/toddler care. There are no bodies of water on the premises. Firearms and ammunition are not on the premises. Assistant Director stated there are no poisons on premises. Disinfectants, hazardous items and medications are inaccessible to children. Fire drills are conducted every month and documented with the last conducted on 9/11/19. Rooms are safe and clean. The facility is in compliance with conditions and limitations specified on the license. All staff subject to a criminal record clearance or exemption are associated to the facility. At least one staff on site has a current Pediatric First Aid/CPR which expired in 05/2021 Children records were reviewed and contained all of the required documentation. Records for all staff for all staff present were reviewed and contained at the required documentation.

Needs and Services plans reviewed for some infants. LPAs observed that the needs and services were not updated quarterly, or as often as necessary to assure accuracy.

(Report continued on page 2)
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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-CALVINE
FACILITY NUMBER: 343603512
VISIT DATE: 09/27/2019
NARRATIVE
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The facility currently does not have any children on medication. However, 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. When any IMS is provided, a Plan for Providing 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.

LPA provided the Community Care Licensing’s 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.

Lead Exposure Effect and Safe Sleep brochure was reviewed and provided to the facility.

Deficiency cited on the subsequent page of this report under the California Code of Regulations, Title 22. Facility was provided a copy of the Appeal Rights (LIC9058). See subsequent LIC 809 page for deficiency cited.



Exit interview conducted and Notice of Site Visit was provided and posted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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-CALVINE
FACILITY NUMBER: 343603512
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
Section Cited

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The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. This requirement was not met as
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evidenced: Based on record reviewed, LPAs observed multiple infant and needs and services not updated at least quarterly or as often as necessary to assure its
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accuracy, which poses a potential health and safety risk to children in care.

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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3