343615586-11-17-2023-03-CC-MPEZ-CXNTTQ-20231117140108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343615586
Report Date: 11/17/2023
Date Signed: 11/17/2023 02:01:22 PM

Document Has Been Signed on 11/17/2023 02:01 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	MERRYHILL SCHOOL - KARITSA		FACILITY NUMBER:	343615586
ADMINISTRATOR:	SUSAN LEPAGE		FACILITY TYPE:	830
ADDRESS:	2855 KARITSA AVENUE		TELEPHONE:	(916) 575-9603
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95833
CAPACITY:	40	CENSUS: 17	DATE:	11/17/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Yvonne Valenzuela		TIME COMPLETED:	02:30 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) Michelle Perez met with Facility Representative/Director Yvonne Valenzuela, for the purpose of an unannounced annual random inspection. Upon arrival, there were seventeen (17) children present with five (5) teachers (three fully qualified & two aides). All staff had criminal record clearance. The facility is open Monday - Friday from 06:30 am to 06:00 pm. LPA verified all infant sleep forms LIC 9227, infant needs and service plans as well as all infant sleep logs. Infant cribs are within regulation, there are no items inside of them. LPA witnessed clean sheets that are changed daily. All bottles, cups and food items are properly labeled and stored correctly. The floor is clean and tidy. LPA toured the facility inside and out for a health and safety inspection. Physical plant- The facility is orderly and suitable for children. Cleaning supplies and hazardous items were inaccessible to children. Medication is stored in a safe place inaccessible to children in care. Outdoor activity space and equipment was in good repair. Uncontaminated drinking water is available both indoors and outdoors. Facility has a current fire/disaster drill log. LPA observed a first aid kit and storage of medications. LPA observed that solid waste storage vessels/bins had tight fitting covers on and in good repair. All toilets and hand washing facility is safe and sanitary operating condition. Facility has license, parent’s rights, emergency evacuation, and car seat safety posted.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle Perez	TELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MERRYHILL SCHOOL - KARITSA	FACILITY NUMBER: 343615586
	VISIT DATE: 11/17/2023

NARRATIVE

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Facility Administration- The department has inspection authority. LPA observed that at least one staff member has current CPR and Pediatric First Aid. All Mandatory Reporting training was current. LPA reviewed the Departments 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 10 working days.

Evaluation of care and supervision- LPA observed that all children were being supervised during the inspection. Capacity and ratio requirements were being met.

FACILITY RECORDS REVIEW- children’s records included emergency contact. Staff personnel record contained documentation of the educational backgrounds, training, and
or experience.

Facility was tested for lead and understand testing will continue every 5- years.

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: http://www.ada.gov/childqanda.htm.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle Perez	TELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MERRYHILL SCHOOL - KARITSA	FACILITY NUMBER: 343615586
	VISIT DATE: 11/17/2023

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The facility evaluation report was reviewed and discussed with the Yvonne Valenzuela. A notice of site visit was provided and should remain posted for a period of 30 days for parental review. 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. Their signature on this form acknowledges receipt of this form.

Based upon today’s inspection, no Title 22 deficiency was cited.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle Perez	TELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC809 (FAS) - (06/04)

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