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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617554
Report Date: 09/19/2019
Date Signed: 09/19/2019 12:21:51 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-MIDTOWNFACILITY NUMBER:
343617554
ADMINISTRATOR:CHIU, EUPHEMIAFACILITY TYPE:
850
ADDRESS:2600 V STREETTELEPHONE:
(916) 429-6055
CITY:SACRAMENTOSTATE: CAZIP CODE:
95818
CAPACITY:24CENSUS: 22DATE:
09/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Elaine WestphalTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kristal Goodell met with School Principal "Elaine" Mary Westphal and director Euphemia for an unannounced Annual Inspection. The Facility’s hours of operation are Monday- Friday, 6:30am-6pm. Staff members present during inspection have been fingerprint cleared through Community Care Licensing.

LPAs toured the facility including all activity/classroom areas, food service area and restroom. During inspection, LPA observed 22 children with two staff members. The School Principal stated that the facility provides morning and afternoon snack. Lunch provided by parents or purchased upon request. LPA observed a current menu and activity schedule posted in the entrance of the facility's classroom. LPA also observed the outdoor activity space and playground equipment. LPA observed drinking water is made readily available to children both indoors and outdoors. LPA observed cleaning compounds are inaccessible to children. LPA observed fire drill log and children roster. LPA observed that medications are centrally stored and inaccessible to children. LPA reviewed children’s files. LPA also reviewed staff files and educational background/transcripts. LPA observed that staff member present with the most current Pediatric CPR/First Aid expired on 10/9/18.

Report continues on LIC 809C
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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-MIDTOWN
FACILITY NUMBER: 343617554
VISIT DATE: 09/19/2019
NARRATIVE
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LPA obtained the facility’s email address to enroll in Quarterly Updates. Community Care Licensing website www.ccld.ca.gov, was provided so the facility can obtain updated licensing information, new regulations, self-assessment guides, and access forms. LPA advised the facility of their responsibility to stay current in regards to new regulations.

Title 22 Deficiency cited on next page. Report was reviewed and Appeal Rights were discussed. Notice of Site Visit posted and the director understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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-MIDTOWN
FACILITY NUMBER: 343617554
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2019
Section Cited

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Personnel Requirements. At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.
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This requirement is not met due to LPA observed staff members most current CPR/1st Aide expired 10/9/18.
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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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3