343617554-11-16-2023-03-CC-DVAG-CXN2VV-20231116164433

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343617554
Report Date: 11/16/2023
Date Signed: 11/16/2023 04:44:39 PM

Document Has Been Signed on 11/16/2023 04:44 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 - MIDTOWN		FACILITY NUMBER:	343617554
ADMINISTRATOR:	KELLY ZELAYA		FACILITY TYPE:	850
ADDRESS:	2600 V STREET		TELEPHONE:	(916) 429-6055
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95818
CAPACITY:	24	CENSUS: 18	DATE:	11/16/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:33 PM
MET WITH:	Katrina Duke		TIME COMPLETED:	05:00 PM

NARRATIVE

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At 2:33 p.m. on Thursday, November 16th, 2023, Licensing Program Analyst (LPA) Pa Dao Vang met with Director, Katrina Duke and Head of School Rachel Kennedy, for the purpose of an unannounced required annual inspection. LPA observed a census of 18 children supervised by 3 staff. Facility hours of operation are from 7:00 a.m. - 6:00 p.m., Monday thru Friday.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA conducted a health and safety inspection of the classroom and restrooms. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Director stated that there are no firearms nor poisons on the premises.

Facility provides morning and afternoon snacks for the children. Parents provide lunch for the children. Facility utilizes an electronic sign in and sign out program on a tablet for parents and teachers to log children in daily.

Facility provides Incidental Medical Services. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

Continue report on LIC809-C...

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

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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Document Has Been Signed on 11/16/2023 04:44 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MERRYHILL SCHOOL - MIDTOWN	FACILITY NUMBER: 343617554
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the facility did not comply with the section cited above in 1 out of 3 staff did not have Tdap in their personnel file, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2023
	Plan of Correction
1 2 3 4	Director will obtain staff's Tdap record to be kept in personnel file. Direcotor will also emial LPA at padao.vang@dss.ca.gov an electronic copy of the form to clear off Plan of Correction.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

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 - MIDTOWN	FACILITY NUMBER: 343617554
	VISIT DATE: 11/16/2023

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LPA conducted a health and safety inspection of the outdoor space. Playground equipment and surfaces were free of loose or sharp parts. Outdoor shade was provided by a small canopy, tree, and building. Water is accessible via labeled bottles. Water is also provided and accessible in the classroom for children.

LPA reviewed staff and children's records. Each child's file contained an admission agreement, emergency card, health history, immunizations, and acknowledgement of receipt of personal rights, consent for emergency medical treatment, and parent’s rights. LPA observed CPR and First aid certification for at least one staff on the facility premises. LPA observed health screening, current AB 1207 Mandated Reporter training certificates, employee rights, and documentation of the educational background, training, and/or experience. LPA observed a staff missing Tdap in their personnel file.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Title 22 deficiency is cited on the subsequent pages of this report. An exit interview was conducted with the Director, Katrina Duke. Appeal rights and a notice of site visit were provided. Notice of site visit shall remain posted for a period of 30 days.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC809 (FAS) - (06/04)

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