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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623338
Report Date: 03/18/2022
Date Signed: 03/18/2022 12:58:01 PM


Document Has Been Signed on 03/18/2022 12:58 PM - 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:MERRYHILL SCHOOL-ROCKLINFACILITY NUMBER:
313623338
ADMINISTRATOR:JILL MCSPADDENFACILITY TYPE:
850
ADDRESS:5893 STANFORD RANCH RDTELEPHONE:
(916) 624-4511
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:162CENSUS: 70DATE:
03/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Jill McspaddenTIME COMPLETED:
01:15 PM
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On March 18, 2022 Licensing Program Analyst (LPA) Jeremey McClain and Office Technician Khaterra Jamil met with Director Jill Mcspadden for an unannounced Case Management Inspection regarding an Unusual Incident Reported received via email on March 10, 2022.

LPA observed 70 children, supervised by 12 staff members in six different rooms.

It was reported that a child fell while climbing a ladder on the playground outside. The child suffered a cut to their head that required them to be taken in for emergency care. The cut was glued and did not require stitches. LPA observed the structure where the injury occurred and interviewed the teacher who was supervising during the incident.

LPA determined that there was adequate cushioning under the play structure and did not consider the play structure to be hazardous. There was no evidence to support that there was a lack of supervision.

An exit interview was conducted, and this report was reviewed with the director.


This report was reviewed with the license. LPA provided a Notice of Site Visit, which must remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022
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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