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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400322
Report Date: 08/16/2023
Date Signed: 08/16/2023 11:08:52 AM


Document Has Been Signed on 08/16/2023 11:08 AM - 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, 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:
08/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director Viola LewTIME COMPLETED:
11:15 AM
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On Wednesday, August 16, 2023, at 10 am, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management Visit. LPA met with the Director Viola Lew. The Licensee submitted Rooms Addition Application, received on 08/07/2023 at the Oakland Child Care Regional Office, returned on 08/07/2023 due lack of an application fee, and as per the Director the application was mailed back on 08/15/2023.

The Licensee requested 2 waivers, (8/9/2023) one is to use the 2 Unlicensed Room 10 and 4, temporarily, until the Rooms Addition Application is completed due to the permanent closure of the other Facility MERRYHILL SCHOOL 1071 434400323 effective 08/18/2023. Children and Staff from the other site will be transferring to this facility. (06/13/2023) the other one is to use and share the Portable Restroom with Jr K and 1st Grade.

There were no children present on this visit and all the Staff are having their In Service Training.

The Licensee has requested to add Room 10 (previously licensed as Beginner Room and were licensed for 22 preschool children) and Room 4 (portable on backside of campus and were used by 24 kindergarten). The facility's licensed room are Room #8 and #9, previously named as Room #2 and #3, and Intermediate Rooms. The facility is located in Merryhill School.

LPA conducted a health and safety inspection with the Director. The campus is currently undergoing a renovation and expected to complete before the school year starts on 08/21/2023. The classrooms #8 and #9, #4 and #10, classroom restrooms and portable restroom for children.

LPA advised the Director the application process and Waiver approval is pending as per LPM Jang. LPA advised the Director to submit an updated LIC 500 and LIC 9040.

There are no deficiencies cited during today's visit. An exit interview was conducted with the Director Viola Lew.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023
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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