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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393615579
Report Date: 06/16/2023
Date Signed: 06/16/2023 05:12:23 PM


Document Has Been Signed on 06/16/2023 05:12 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: 0DATE:
06/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Tammy WellsTIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA) David Nguyen met with Principal, Tammy Wells to follow up on the Unusual Incident Report (UIR) submitted to Community Care Licensing on June 15th, 2023.

LPA toured the facility, observed the playground, play structure, and outdoor play equipment, reviewed records and conducted interview.

Facility evaluation report was reviewed and discussed with Principal, Tammy Wells. Exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2023
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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