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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400322
Report Date: 07/01/2021
Date Signed: 07/01/2021 02:37:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MERRYHILL SCHOOL 1070FACILITY NUMBER:
434400322
ADMINISTRATOR:LEW, VIOLAFACILITY TYPE:
850
ADDRESS:1500 YOSEMITE DRIVETELEPHONE:
(408) 945-9090
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:50CENSUS: 0DATE:
07/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:44 PM
MET WITH:Viola LewTIME COMPLETED:
02:45 PM
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On Thursday, July 1, 2021 1:44 PM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 year visit. LPA met with the Preschool Director Viola Lew and explained the purpose of the visit. Upon arrival, LPA was informed that the Preschool has ceased operation since 3 years ago.

The Director stated that the Preschool Program has not been enrolling children since 05/28/19 and is planning to start enrollment for the upcoming Fall 2021-2022 school year. Director requested to keep the facility in Active Status until the facility starts school year in Fall.

LPA toured the facility to conduct a Health and Safety Inspection. There are two (2) classrooms that are licensed for preschool, Classroom #2 and #3 that is located on Merryhill Elementary School Campus. LPA observed that classroom #3 is currently being use for K-Readiness Program (ages from 5 to 6 years old). The Preschool has been granted a waiver to allow Preschool children to use the Elementary school playground for Kindergarteners. Outdoor activity space is fenced and play equipment were maintained in a safe condition and free of hazards. There were no bodies of water observed. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls.

The Director completed the CHILD CARE COVID-19 WAIVER ATTESTATION FORM Pediatric CPR and First Aid Certification.

LPA provided the following information;
1. Lead Poisoning Prevention Requirement
2. LIC 311 A
3. AB1207 renewal.
SEE 809C.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MERRYHILL SCHOOL 1070
FACILITY NUMBER: 434400322
VISIT DATE: 07/01/2021
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Continuation.....

In the areas that were evaluated, no regulatory violations were observed at the time of the visit.

Exit Interview was conducted, where this report was reviewed and discussed with Preschool Director.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

End of report.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
LIC809 (FAS) - (06/04)
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