434400323-7-22-2021-52-CC-MESA-C56Q4U-20210722115055

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400323
Report Date: 07/22/2021
Date Signed: 07/22/2021 11:51:06 AM

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 1071		FACILITY NUMBER:	434400323
ADMINISTRATOR:	CHERYL BOWMAN		FACILITY TYPE:	850
ADDRESS:	123 CORNING AVENUE		TELEPHONE:	(408) 946-2812
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	78	CENSUS: 23	DATE:	07/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Darice Johnson		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Thursday, July 22, 2021 at 9:00 AM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year visit. LPA met with the Director / Principal Darice Johnson and explained the nature of site visit. Present on this visit were 6 staff and 23 preschool children. Facility has a current waiver for Sign In and Out. Facility operates from Monday to Friday 7:30 AM to 5:30 PM. LPA toured the facility to with the Director to conduct a Health and Safety Inspection. Facility’s License, Parents’ Rights Poster, Personal Rights, Waiver and Activity Schedules were observed to be posted. LPA observed to be in compliance with teacher to children ratio requirement. Children were engaged in various activities under the visual supervision of the teachers. The preschool classrooms (Beginners, Intermediate, 2 Pre K), children's and staff restroom and kitchen, were inspected. Director stated that facility does not possess nor store any weapons on the premises. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Furniture and equipment such as mats, cots, tables, and chairs were age appropriate and were in good condition, free of sharp, loose, or pointed parts. Restrooms for children's use and staff were observed to be in safe, sanitary, and functioning condition. 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. There were shaded rest areas for children. Drinking water are arranged to be readily available to children during indoor and outdoor activities. Food and beverages were kept protected against contamination and spoilage. Menu was posted. Kitchen and food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on, and were in good repair. SEE 809 C....

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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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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 1071	FACILITY NUMBER: 434400323
	VISIT DATE: 07/22/2021

NARRATIVE

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Facility files were reviewed. Children sign in and out procedures and logs were reviewed. A random sampling of Children's files was selected for review. The records reviewed include Admission Agreement, Identification and Emergency Information, Medical Assessment, and Immunization.

A random sampling of Staff's files was selected for review. The records reviewed include: Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, Education Qualification, records of immunization (Measles and Pertussis), and Training. Staff have their AB1207 Mandated Reporter Training Certifications in their file. LPA reminded Director that the training needs to be renewed every two years.

Facility does not provide transportation for children but Director understands that children cannot be left alone, unattended in park vehicles. First Aid Kit was inspected. Fire extinguisher was last serviced on April 2021. LPA observed that the facility has a Fire Alarm Pull Station and Carbon Monoxide Detectors. Disaster drill was last conducted in May 2021.

Director stated that facility does handle medications and is providing Incidental Medical Services – IMS: Epinephrine and Inhaled Medication. LPA reviewed storage of medication and equipment/supplies and Facility's current IMS Plan for Epinephrine, and reviewed children’s, personnel, and administrative records. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov
SEE 809 C....

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 1071	FACILITY NUMBER: 434400323
	VISIT DATE: 07/22/2021

NARRATIVE

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The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

LPA discussed and copies provided the following;

1. PIN 20-01 REQUIRED LEAD TESTING FOR DRINKING WATER IN LICENSED CHILD CARE CENTERS AND THE PROVISION OF LEAD EXPOSURE INFORMATION TO PARENTS AND GUARDIANS BY ALL LICENSED CHILD CARE FACILITIES

2. LEAD PUB 515.
3. Santa Clara Resource and Referral Santa Clara County Office of Education
Childcare Resource & Referral Program
Email: childcarescc@sccoe.org
Phone: 669-212-KIDS (5437
4. Child Care Stipends
5. Guardian.

In the areas that were evaluated, no deficiencies were observed at the time of the visit. Exit Interview was conducted with Director.

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

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC809 (FAS) - (06/04)

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