343608219-8-16-2019-53-CC-JBIK-BF4TZS-20190816151049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343608219
Report Date: 08/16/2019
Date Signed: 08/16/2019 03:11:01 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-HARBOUR PT.		FACILITY NUMBER:	343608219
ADMINISTRATOR:	STEPHANIE GILL		FACILITY TYPE:	850
ADDRESS:	9561 HARBOUR PT. DRIVE		TELEPHONE:	(916) 683-3244
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	120	CENSUS: 94	DATE:	08/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Stephanie Gill-Director and Maybeline Dela Cruz-Assistant Director		TIME COMPLETED:	03:20 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	Licensing Program Analyst (LPA) Jeevun Birk-Miller and Mai Lor met with Director Stephanie Gill and Assistant Director Maybeline Dela Cruz for the purpose of an unannounced annual random inspection. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Census included 94 preschool children supervised by thirteen staff members who all have obtained a criminal record clearance through Community Care Licensing. Facility hours of operation are Monday through Friday from 6:30 AM-6:00 PM. Children take naps at the facility. The facility offers morning snacks, lunch and afternoon snacks, which is prepared at the facility. Facility properly stores food and all food items contain labels. LPA toured all activity and classroom spaces, restrooms, food service, and outdoor play areas. Medications are appropriately stored and inaccessible to children. Director stated there are no bodies of water or fire arms on the premises. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with padding to absorb the fall. Toileting facilities are in safe, sanitary and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Menus were posted and drinking water was readily available to children both indoors and outdoors. LPA observed full legal signatures while reviewing the hand-written sign in and sign out sheet. Staff and children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification, which expires on 06/2021.Six staff records were reviewed and one staff (S3, see LIC 811 for confidential names list dated 8/16/19) record did not have a current health screening and tuberculosis. LPA verified documentation of the educational background, training, and/or experience. (Report continues on 809-C)

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun Birk	TELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

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-HARBOUR PT.	FACILITY NUMBER: 343608219
	VISIT DATE: 08/16/2019

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
26
27
28
29
30
31
32

LPA reminded Director that 100% supervision is required at all times, including in the bathroom. LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days.
The facility is providing Incidental Medical Services. 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: www.ada.gov/childqanda.

LPA verified the annual fees are current

Director was encouraged to the visit the department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

In the areas that were evaluated, the following Type-B citation were cited under Title 22 California Code of Regulation on the 809-D page.This facility evaluation report was reviewed and discussed with Director; she stated she understands today's inspection. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun Birk	TELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

LIC809 (FAS) - (06/04)

Page: 2 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-HARBOUR PT.	FACILITY NUMBER: 343608219
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/16/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/30/2019 Section Cited CCR 101216(g)(1)	1 2 3 4 5 6 7	Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.This requirements has not been met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to send copy of the one staff's health screenings tuberculosis to CCL by 8/1/19.
	8 9 10 11 12 13 14	Based on record review the licensee failed to ensure that one staff file (S3) had the required health screenings and tuberculosis. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun Birk	TELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3