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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393615579
Report Date: 04/24/2024
Date Signed: 04/24/2024 04:39:20 PM


Document Has Been Signed on 04/24/2024 04:39 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:MERRYHILL SCHOOL - TRINITYFACILITY NUMBER:
393615579
ADMINISTRATOR:TAMARA WELLSFACILITY TYPE:
850
ADDRESS:10250 TRINITY PARKWAYTELEPHONE:
(209) 474-0518
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:163CENSUS: 83DATE:
04/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Wells, TammyTIME COMPLETED:
04:45 PM
NARRATIVE
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On April 24th, 2024, at 1:00 PM, Licensing Program Analysts (LPAs), David Nguyen and Elizabeth Santiago conducted an unannounced field visit to the facility for the purpose of a case management inspection to follow up on two (2) separate incidents--occurred on April 16th, 2024, and on April 22nd, 2024--reported to LPA Nguyen via email on April 22nd, 2024, and on April 23rd, 2024. LPAs arrived at the facility and were met by Director, Tammy Wells. LPAs disclosed the purpose of the inspection and were granted entrance into the facility by the facility representative. Eighty-three (83) preschool aged children were present during today’s inspection. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

LPAs Nguyen and Santiago toured the facility, observed the care and supervision of children, reviewed records and conducted onsite interviews with director and teachers. Interviews corroborated what was reported in the Unusual Incident Report (UIR) dated on April 16th, 2024: one (1) child (C1) opened the playground’s gate and wandered away from the facility playground for approximately four (4) minutes during outdoor play time, and two (2) strangers found C1 in facility’s parking lot, brought C1 back to C1’s childcare center, and Director, Tammy Wells retrieved C1 from the two strangers, which was an absence of supervision and which poses an immediate health, safety, or personal rights risk to persons in care.

Report continues on LIC809-C...(Page 2)

SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MERRYHILL SCHOOL - TRINITY
FACILITY NUMBER: 393615579
VISIT DATE: 04/24/2024
NARRATIVE
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(Page 2)
In addition, interviews corroborated what was reported in the Unusual Incident Report (UIR) dated on April 22nd, 2024: one (1) child (C2) was left unattended on the playground for approximately three (3) minutes during transition, and a staff member (S1) brought the child back to the classroom, which was also an absence of supervision and which also poses an immediate health, safety, or personal rights risk to persons in care.

As a result of the absence of supervision, one (1) Type A violation was cited on a subsequent 809-D page and a Civil Penalty was being assessed.

Director Tammy Wells understands that all parents or authorized representatives of currently enrolled children must sign the LIC 9224 form and be available to the Department for review. Director understands that parents or authorized representatives of children enrolling for up to one year must sign the LIC 9224 form and be available to the Department for review. Director acknowledged that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809-D with Type A deficiencies for 30 days.



An exit interview was conducted, and the report was reviewed with Director, Tammy Wells. LPA provided Director with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/24/2024 04:39 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: MERRYHILL SCHOOL - TRINITY
FACILITY NUMBER: 393615579

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/24/2024
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher… Supervision shall include visual observation.
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Staff Meeting will be held to focus on Supervision on 5/24/24 which includes training on supervision. Director will email LPA the sign-in sheet from this meeting.
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Based on record reviews and interviews, C1 wandered away from the playground, and C2 was left unattended on the playground, resulting in an absence of supervision, which poses an immediate risk to children in care.
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Director will create a written statement for staff to sign that describes supervision policy and procedures will be expected of staff for the future.

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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: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3