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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393615579
Report Date: 03/08/2022
Date Signed: 03/08/2022 03:28:02 PM


Document Has Been Signed on 03/08/2022 03:28 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



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: 69DATE:
03/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Tamara Wells TIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of conducting a case management inspection. LPA met with Facility Representative. LPA observed sixty nine (69) children supervised by fourteen (14) staff.

Community Care Licensing received information alleging that a communicable virus surfaced in the Beginners classroom of the facility in early December 2021. Interviews conducted with facility staff and parents confirmed the allegation. Parents were notified of the virus; however, Community Care Licensing was not informed.

Based on the information received, Title 22 deficiencies will be cited on subsequent page, LIC 809D.

Exit interview conducted with Facility Representative, Tamara Wells. Appeal rights and a Notice of Site Visit was provided and shall remain posted for 30 days.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
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 03/08/2022 03:28 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833


FACILITY NAME: MERRYHILL SCHOOL-TRINITY
FACILITY NUMBER: 393615579

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2022
Section Cited

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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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Epidemic outbreaks.
This requirement was not met as evidenced by: A communicable virus surfaced in the Beginners classroom of the facility in early December 2021. Community Care Licensing was not informed. This poses a potential risk 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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
LIC809 (FAS) - (06/04)
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