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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343608219
Report Date: 05/12/2023
Date Signed: 05/12/2023 10:35:57 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/05/2023 and conducted by Evaluator Nola Maestas
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20230405170612
FACILITY NAME:MERRYHILL SCHOOL-HARBOUR PT.FACILITY NUMBER:
343608219
ADMINISTRATOR:STEPHANIE GILLFACILITY TYPE:
850
ADDRESS:9561 HARBOUR PT. DRIVETELEPHONE:
(916) 683-3244
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:120CENSUS: 101DATE:
05/12/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Stephanie GillTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff caused injuries to day-care child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/12/2023, Licensing Program Analyst Katy Maestas (LPA) conducted an unannounced field visit to deliver the findings for the above allegation. LPA arrived at the facility and was met by Director Stephanie Gill (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility.
Throughout the course of the investigation, LPA reviewed the facility’s file, collected and reviewed documents pertaining to the allegation, and conducted observations and interviews. It was alleged that a staff member caused injuries to a day-care child approximately 2 years ago. Interviews reveal conflicting information, and the lapse of time caused a decrease in evidence.
Based on interviews, observations, documentation, and other information gathered, there was not a preponderance of evidence to prove or negate the allegation, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with the D1 and Appeal Rights were provided by LPA. A Notice of Site Visit was posted by LPA and this shall be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Nola MaestasTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
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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