570311280-9-15-2021-53-CC-JLDN-C89KVF-20211029081416

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 570311280
Report Date: 09/15/2021
Date Signed: 09/15/2021 01:39:32 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
08/16/2021 and conducted by Evaluator Chayntel Hunter

COMPLAINT CONTROL NUMBER: 53-CC-20210816114110

FACILITY NAME:	MERRYHILL SCHOOL-LA VIDA		FACILITY NUMBER:	570311280
ADMINISTRATOR:	ASHLEY TOBUREN		FACILITY TYPE:	850
ADDRESS:	222 LA VIDA WAY		TELEPHONE:	(530) 753-9210
CITY:	DAVIS	STATE: CA	ZIP CODE:	95618
CAPACITY:	88	CENSUS:	DATE:	09/15/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Principal, Ashley Toburen		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Personal Rights: A child was bitten by a child in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Chayntel Hunter spoke with Principal, Ashley Toburen to deliver the findings of the complaint investigation regarding the above allegation. During the course of the investigation, LPA Hunter conducted interviews, reviewed the facility's biting policy and obtained information pertaining to the allegation. It was alleged that a child was bitten by another child (C1) while in care.

Through interviews conducted it was revealed that although staff had followed their biting policy, there were still multiple confirmed biting incidents by C1. Based on the interviews and review of records that revealed thirteen biting incidents over a six month period, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The following Title 22 Deficiency is being cited on the subsequent 9099-D pages. Upon receipt of Type A citations, 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. Appeal Rights and Notice of Site Visit were provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 53-CC-20210816114110

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: 09/15/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/16/2021 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations... to meet his/her needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Principal stated that C1 has been removed from the original classroom, and has not since had any recent biting incidents. Additional staff have been hired to help supervise children to prevent future occurrences. LPA cleared the deficiency during the visit.
	8 9 10 11 12 13 14	Based on interviews conducted and review of records it was determined that C1 had thirteen confirmed biting incidents over a six month period. This is an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

LIC9099 (FAS) - (06/04)

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