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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614049
Report Date: 04/18/2023
Date Signed: 04/18/2023 12:38:59 PM


Document Has Been Signed on 04/18/2023 12:38 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:MERRYHILL SCHOOL-DANBROOKFACILITY NUMBER:
343614049
ADMINISTRATOR:ROBIN KEMMERFACILITY TYPE:
850
ADDRESS:1901 DANBROOK DRTELEPHONE:
(916) 285-8656
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:120CENSUS: 100DATE:
04/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Robin KemmerTIME COMPLETED:
12:55 PM
NARRATIVE
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On Tuesday, April 18th, 2023, Licensing Program Analyst (LPA) Arianna Manabat conducted a Case Management Inspection for the purpose of addressing an unusual incident report. Today, LPA met with Director Robin Kemmer and discussed the purpose of the visit. Preschool census included 100 infant children in care with 14 staff, including the Director and Assistant Director.

On Thursday April 13th, 2023, LPA Manabat received an Unusual Incident Report from the facility regarding a self reported incident from the facility Director. Director sent in an Unusual Incident Report to the Sacramento Regional Office regarding an incident which occurred on April 11th, 2023. The incident was pertaining to an situation where Staff member (S1) hit a child's (C1) hand. LPA learned that the Director was notified about the incident from the child's authorized representative on April 12th, 2023. LPA found that the Director immediately sent in an Unusual Incident Report to the Sacramento Regional Office and reported the incident verbally within 24 hours, and 7 days via writing.

On the report, it was stated that S1 hit C1's hand during activity time. During today's inspection, LPA discussed the incident with the Director and was shown footage of S1 hitting the back of C1's hand. LPA learned that the Director immediately interviewed relevant staff members, spoke to Merryhill corporate HR, reviewed and saved video footage, spoke to C1's authorized representative, and ensured that the child's mental and physical health were assessed. After reviewing this information and interviewing S1, the Merryhill facility chose to immediately terminate the staff member.

During today's investigation, LPA reviewed the relevant documentation, interviewed the Director, and reviewed video footage. Based on the information received, LPA Manabat will issue a type A citation, as a Title 22 violation has occurred. See page 809-D for deficiency cited. Exit interview was conducted and a copy of this report was given to the Director. Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Arianna ManabatTELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2023
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 2


Document Has Been Signed on 04/18/2023 12:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: MERRYHILL SCHOOL-DANBROOK
FACILITY NUMBER: 343614049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/19/2023
Section Cited

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101223 Personal Rights: (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation,... threat, mental abuse or other actions of a punitive nature...
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Coorperate for Merryhill has taken preventative and corrective action to terminate the employee and disassociate the staff member (S1) from the faciltiy. LPA has cleared the citation as of 04/18/2023.
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This requirement was not met as evidenced by: LPA reviewed footage from the facility which showed a staff member (S1) hitting the hand of a child (C1). This poses an immediate threat to the health and safety of children in care.
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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: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Arianna ManabatTELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2023
LIC809 (FAS) - (06/04)
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