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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343608220
Report Date: 08/15/2024
Date Signed: 08/15/2024 03:55:36 PM


Document Has Been Signed on 08/15/2024 03:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 - HARBOUR POINTFACILITY NUMBER:
343608220
ADMINISTRATOR:STEPHANIE GILLFACILITY TYPE:
830
ADDRESS:9561 HARBOUR PT. DRIVETELEPHONE:
(916) 683-3244
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:30CENSUS: 22DATE:
08/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Robin KemmerTIME COMPLETED:
04:00 PM
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On 08/15/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a case management inspection. LPA arrived at the facility and was met by the acting Director Robin Kemmer (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA toured the facility and observed 22 infants being supervised by 5 staff members. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

An incident on 08/07/2024 was cross reported to the Department. LPA conducted staff interviews and reviewed files and documents relating to the incident.

An exit interview was conducted, and the report was reviewed with Director Kemmer. LPA provided D1 with Licensee Appeal Rights. 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 GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy VelazquezTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2024
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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