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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570311280
Report Date: 09/18/2019
Date Signed: 09/18/2019 04:02:50 PM

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-LA VIDAFACILITY NUMBER:
570311280
ADMINISTRATOR:MCSPADDEN, JILLFACILITY TYPE:
850
ADDRESS:222 LA VIDA WAYTELEPHONE:
(530) 753-9210
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:88CENSUS: 52DATE:
09/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jill McSpadden, PrincipalTIME COMPLETED:
04:20 PM
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Licensing Program Analysts (LPAs) Joleen Kenney and Chayntel Hunter met with Principal, Jill McSpadden to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 08/08/19. During today's visit the facility was toured. Present were 10 toddler option children, and 42 preschoolers supervised by 6 staff.

LPAs reviewed and discussed this incident with the Principal.

The facility reported the UIR to Community Care Licensing within 24hrs and submitted a written UIR within 7 days which meets regulation requirements. The UIR described the specifics of the incident.

Notice of Site Visit was posted. This report was reviewed and discussed with the Principal.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
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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