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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603512
Report Date: 11/06/2019
Date Signed: 11/06/2019 03:26:16 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-CALVINEFACILITY NUMBER:
343603512
ADMINISTRATOR:GATBONTON, NIEVAFACILITY TYPE:
830
ADDRESS:9036 CALVINE ROADTELEPHONE:
(916) 689-7322
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:28CENSUS: 12DATE:
11/06/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Nieva GatbontonTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Mai Lor conducted an unannounced plan of correction inspection. LPA met with Director Nieva Gatbonton. Upon arrival, LPA observed 12 infants in care. During this inspection, LPA reviewed a random sample of infant needs and services plans and verified that they have been updated. All plan of correction have been met.

Exit interview conducted. No Title 22 Regulations cited during this inspection. A 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: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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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