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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 570311280
Report Date: 10/25/2019
Date Signed: 10/25/2019 12:23:55 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2019 and conducted by Evaluator Chayntel Hunter
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20191022171828
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:
95618
CAPACITY:88CENSUS: 53DATE:
10/25/2019
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Principal, Jill McSpaddenTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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9
Other- Staff failed to notify responsible party of incidents.
Other- Daycare child eloped from the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Chayntel Hunter and Licensing Program Manager (LPM) Sharon Ogbodo conducted an unnanounced complant inspection, and met with Principal, Jill McSpadden. It was alleged that a child (C1) eloped from the facility and that staff failed to notify the responsible party of the incidents.

LPA and LPM conducted a tour of the classroom, interviewed staff, and reviewed documents, which identified that C1 had 3 incidents that involved the child eloping from the facility, and 2 incidents where C1 eloped from the classroom. Although it was stated that teachers was present, and observed the incidents, it was determined that the child's needs were not met due to C1 eloping on multiple occassions. It was also determined that staff did not consistently report all incidents to the responsible party. Although the teacher documented the incidents, there is no evidence that the responsible party received notification of these incidents.

Report continues on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2019 and conducted by Evaluator Chayntel Hunter
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20191022171828

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:
95618
CAPACITY:88CENSUS: 53DATE:
10/25/2019
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jill McSpadden, PrincipalTIME COMPLETED:
12:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to adhere to the terms and conditions of the contract.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Chayntel Hunter and Licening Program Manager (LPM) Sharon Ogbodo conducted an unnanounced complant inspection, and met with Principal, Jill McSpadden. It was alleged that staff failed to adhere to the terms and condidions of the contract.

LPA and LPM conducted a tour of the classroom, interviewed staff, and reviewed documents, which identified that C1 was suspended, based on the facilitie's Guidance and Discipline Policy. LPA and LPM reviewed the policy, and the policy does state that a behavior plan will be provided, and that after all other possible interventions have been exhausted, suspension may be necessary. Although, the behavior plan was provided for C1, the plan was not discussed with the parents, until after the incidents already occurred, resulting in the parents not knowing of ongoing behaviors.

Report continues on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 53-CC-20191022171828
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 VIDA
FACILITY NUMBER: 570311280
VISIT DATE: 10/25/2019
NARRATIVE
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Therefore, based on the investigation conducted, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBTANTIATED.

No deficiencies cited. Report reviewed and copies provided. Appeal Rights also issued and discussed. Notice of Site Visit issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 53-CC-20191022171828
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 VIDA
FACILITY NUMBER: 570311280
VISIT DATE: 10/25/2019
NARRATIVE
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Based on LPA and LPM interviews and review of documents, the preponderance of evidence standard has been met, therefore the allegations are found to be SUBSTANTIATED.

The following Type A and Type B deficiency was cited on subsequent 9099-D pages.

Upon receipt of Type A citations, the Principal shall post and provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 9099-D in each child's file. Notice of Site Visit must remain posted for 30 days.

Exit interview conducted. Appeal Rights were provided. Notice of Site Visit was provided and posted.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 53-CC-20191022171828
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 VIDA
FACILITY NUMBER: 570311280
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/28/2019
Section Cited
CCR
101229(a)
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7
Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met as evidenced by:
LPA and LPM learned that C1 eloped from the facility three times, and from the
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Facility has installed a loud sounding alarm on the emergency exit gate. The Principal stated the facility will discuss zones/supervision on the playground, purchase walkie talkies for staff, and add stop signs on the doors. LPA cleared citation during today's inspection.
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classroom twice.
This is an immediate health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 53-CC-20191022171828
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 VIDA
FACILITY NUMBER: 570311280
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2019
Section Cited
CCR
101212(f)
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7
Reporting Requirements: The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative. This requirement was not met as evidenced by:
LPA and LPM learned that, although the teacher documented the incidents, there is
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The Principal stated that written documentation will be done, and that documents will be signed by authorized representatives. LPA cleared citation during today's inspection.
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no evidence that the responsible party received notification of these incidents.

This is a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
LIC9099 (FAS) - (06/04)
Page: 6 of 6