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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614049
Report Date: 12/28/2021
Date Signed: 12/28/2021 12:41:36 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-DANBROOKFACILITY NUMBER:
343614049
ADMINISTRATOR:HARRAH,CHRISTINEFACILITY TYPE:
850
ADDRESS:1901 DANBROOK DRTELEPHONE:
(916) 285-8656
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:120CENSUS: 77DATE:
12/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Katie MoyerTIME COMPLETED:
12:50 PM
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LPA Pascual met with Katie Moyer for a case management visit on December 28th, 2021 at approximately 11:50 am to review files for preschool children. Upon arrival there were 77 preschool children in attendance. LPA made observations and documented information.

LPA left a report with Katie for the records of the facility.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
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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